Library Instruction Statistics Reporting Form (new) Survey

Librarian

Type of Instruction (required)

Type of Instruction (required) Workshop (database demo, software training, etc.)

Outreach (community and/or campus programs, tours, orientations, etc.)

Library staff development

ENGL 111

UNIV 150

Other Course (please specify)

Title of Workshop, Outreach, or Course (if known)

College

Department

Course Instructor (Last, First)

Date of Session

	MM		DD		YYYY
Date	Date of Session Date Month	/	Day	/	Year

Time of Session

		HH		MM	AM/PM
Time		Time of Session Time Hour	:	Minute	AM or PM

Length of Session

Length of Session in minutes:

Time spent preparing

Time spent preparing in minutes:

Number of Students

Location of Session

Location of Session Branson Classroom

Zuhl Classroom

Other (please specify)

Is there a LibGuide for this course?

Is there a LibGuide for this course? Yes

No

Type of Class

Type of Class Undergraduates, lower division

Undergraduates, upper division

Graduate or professional students

Faculty/Staff

Other (please specify)

Teaching Methods

Teaching Methods Lecture/demo

Hands-on

Other (please specify)

Please record anything else about the session that you would like to have noted for official/statistical purposes.

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