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FOR LIBRARY STAFF ONLY

Please inital after dates

Date received______________

RecĀ“d. By _________________ 

Date Scanned______________

Date on BB ________________

Date Completed ___________
 
END OF TERM Returned to  DEPT.__________________

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Incomplete  Information Returned 
Date ______________________

Staff Name ________________
  

 

                                          COURSE RESERVES SUBMISSION FORM

PRINT OUT AND MAIL TO THE LIBRARY -
OR FAX TO  215-871-6478

Instructor
:__________________________________________    Course Number ______________
Teaching Assistant _________________________________________________

Email :____________________________________________________________

Dept. _____________________           Campus Phone __________________

Course Name   ___________________________________________________________________

 Term Start date_________________ Term End Date _______________________

 New List  _____   Addition to List  _____ No. of students in class ________

FULL BIBLIOGRAPHIC INFORMATION AND CITATIONS ALONG WITH THE TABLE OF
CONTENTS (TOC) FOR BOOKS MUST BE PROVIDED. Please ATTACH (TOC) to  FORM.

Incomplete forms  will be sent back to the Dept.
_____________________________________________________________________________________

IF AVAILABLE IN
PCOM LIBRARY  PROVIDE CALL NUMBER_______________________________

AUTHOR       __________________________________________________________________

_______________________________________________________________________________

BOOK/JOURNAL TITLE __________________________________________________________

_______________________________________________________________________________

PUBLISHER________________________________________Year_________________________

PLACE OF PUBLICATION_________________________________________________________

CHAPTER NO. ________    PAGE NUMBERS[BOOKS OR JOURNAL]_____________________

JOURNAL CITATION: VOL._________  ISSUE _________  YEAR__________
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NOTICE: Warning concerning copyright restrictions:The Copyright Law of the United States
(Title 17, US Code) governs the making of photocopies or other reproductions of copyrighted
material. Under certain conditions specified in the law, libraries of archives are authorized
to furnish a photocopy or other reproduction. One of these specified conditions is that the
photocopy or reproduction is not to be "used for any purpose other than private study,
scholarship or research." If a user makes a request for, or later uses a photocopy or
reproduction for purposes in excess of 'fair use', that user may be liable for copyright
infringement.  The library does not sell photocopies, it merely produces them based on
customer request. The library will not be held responsible for copyright infringement.
This library reserves the right to refuse to accept a copying order if, in its judgment,
of the order would involve violation of copyright.
REV. June 3, 2003
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