Library:

ALS NCLC

Request number:

Date:

Date not needed after (Optional):

Patron Name (Optional):

Patron Phone Number (Optional):

Library Staff Information:

Name: Phone number:

E-mail Address:

Question:

(Please explain as clearly as you can what the patron wants to know.
It is helpful to know how the patron will use the information.
For example, the response to a request for "information on Mexico"
would be different for a school report, travel plans, or investment decision).

Describe the information needed: such as, how much information, specific types of sources if specified, and grade level of the requestor. (This field is optional, but very helpful.)

What sources have been checked? (Please enter sources checked or "none.")

Notes/Special Instructions (Optional):