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W.I. Dykes Library

 

UHD Library Course Reserves Request Form

1)  Complete this form fully and submit it online.
2)  Send reserve material either by mail or in-person to the library. 
Your course reserve list will be created when we receive both the form (step 1) and materials (step 2).
For more information visit the Course Reserves page.


Questions?
Contact the UHD Library Course Reserves Staff by email at libraryreserves@uhd.edu.

 

PLEASE COMPLETE THIS FORM IN ITS ENTIRETY: * = REQUIRED FIELDS

 

INSTRUCTOR INFORMATION  
*Last Name:
First Name:
*Phone Number:
*Office/Room#:
COURSE INFORMATION  
*Course Name:
*Course # (e.g. ENG 1111):
*Department:
*Session:
  YOU MUST AGREE TO BOTH OF THE FOLLOWING REQUIREMENTS
OWNERSHIP OF MATERIAL I verify that the material submitted below either a) belongs to the UHD Library OR b) is from my own personal library.  If I am submitting copies from journals or books I verify that I own a personal copy of those original sources.  If I am submitting original published or unpublished student projects or papers I verify that I have acquired written permission via the form Original Materials Permission Form (PDF) (Word Doc)
EVALUATION OF USE I have evaluated each use of my itemized material and have determined that my material: 1) is in the public domain, OR 2) is available in one of the UHD Library databases OR 3) qualifies as Fair Use OR 4) permission has been acquired and I will provide a copy to the Library, OR 5) is student’s original material with accompanying Original Materials Permission Form (PDF) (Word Doc). I will indicate this on the itemized form.
ITEMIZED RESERVE MATERIAL  
  item 1* item 2

* Author

e.g. Smith, John

Article/Chapter Title

e.g. Chapter 1: The Socialhistorical Setting

* Journal/Book Title

e.g. Main Currents in Carribean Thought

* Copyright Evaluation

e.g. 3) fair use

 
provide electronic version
provide electronic version

Check Out Period

e.g. 3 Hour

 

  item 3 item 4

Author

e.g. Smith, John

Article/Chapter Title

e.g. Chapter 1: The Socialhistorical Setting

Journal/Book Title

e.g. Main Currents in Carribean Thought

Copyright Evaluation

e.g. 3) fair use

 
provide electronic version
provide electronic version

Check Out Period

e.g. 3 Hour

 

  item 5 item 6

Author

e.g. Smith, John

Article/Chapter Title

e.g. Chapter 1: The Socialhistorical Setting

Journal/Book Title

e.g. Main Currents in Carribean Thought

Copyright Evaluation

e.g. 3) fair use

 
provide electronic version
provide electronic version

Check Out Period

e.g. 3 Hour

Notes/Comments. If you are at a distance location, please indicate that here.

 

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* Check this check box >>

*  I verify that the material submitted above follows the OWNERSHIP OF MATERIAL criteria AND that I have evaluated the use of each itemized material according to the EVALUATION OF USE criteria.

By submitting this form I am agreeing to the Reserves Agreement term.

 


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make sure all required (*) information and check boxes have been completed.


Use Clear Form only if you want to start over and erase ALL information you have entered on this form.

 

W.I. Dykes Library • University of Houston-Downtown
One Main Street • Houston, Texas 77002
Information 713-221-8187 • Circulation 713-221-8186

 

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Last updated or reviewed on 5/4/12

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