Embedded Librarian Request Form

• First Name: Last Name:
• Phone: E-mail Address:

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• 1. First Course Name: Course number:
  Reference number:
• Choose one:
  Online Supplement Hybrid
• Would you like to embed a specific librarian? Name of librarian:
• Would you also like to schedule an information literacy class? Yes No

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• 2. Second Course Name: Course number:
  Reference number:
• Choose one:
  Online Supplement Hybrid
• Would you like to embed a specific librarian? Name of librarian:
• Would you also like to schedule an information literacy class? Yes No

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• 1. Third Course Name: Course number:
  Reference number:
• Choose one:
  Online Supplement Hybrid
• Would you like to embed a specific librarian? Name of librarian:
• Would you also like to schedule an information literacy class? Yes No

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• After you submit this completed form an embedded librarian will contact you.