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* 1. Name:

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* 2. Email Address:

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* 3. Phone number:

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* 4. Instructional Department:

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* 5. Do you presently have an assignment in your syllabi requiring the use of library resources?

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* 6. The name of the course that you would like to implement Information literacy into for the Fall 2015 semester.

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* 7. Research interest:

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