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INSTRUCTIONS: Please fill out this form as completely as possible in order to assist the reference librarian in providing you with the help you need. Allow a 24 hour business day for acknowledgement of your request. Some searches may take longer. Thank you!

I. Personal data

• Are you currently enrolled in the Dallas County Community College District? Yes No
  
• Do you have access to a local public, college, or university library? Yes No
  
• If so, what library?
  
• Your name:
  
• Daytime Phone: Area Code: Number: -

• Evening Phone: Area Code: Number: -

• Fax Number: Area Code: Number: -

• E-Mail Address:

• Mailing Address (include Apt. No.):

  City: State: Zip Code:

• Which number or address is your preference for the librarian to contact?

• What is the most convenient time to contact you?

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II. Subject

• Description of your search request:

• Please describe any searching you have already done on the topic.

• Would you like to suggest any sources for this search?

• Keywords or phrases for the subject of the request, including synonyms or jargon used in the literature:

• Known documents and/or authors relevant to the topic, if any.

• Briefly describe the purpose of this request (e.g., term paper, short paper, background information for research project, etc., and amount of information needed).

• Indicate your preferences for items to be included in the search. Please check all that apply.
  How recent must the information be?
  Languages:
  Journal or magazine articles
  Books
  Electronic resources
  Other. Please specify.
  
  Geographical areas (such as U.S., Texas) to include: Please specify.
  
  

III. Search Results.

• Date needed:
  
• If there is a fee for a document delivery service, you are responsible for paying that fee. If available only through a document delivery service, are you willing to pay for the item?
  Yes No
• Approximate number items desired:
  
• Desired means of delivery. Place check your first choice.
  Print copy
  Fax
  E-mail
  

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