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High School Visit Request Form

To request a visit send Ken Burhanna (contact information below) the following information. Here is a printable version of the form that you use.

  1. Name of person completing this form:
  2. Teacher’s Name:
  3. Teacher’s phone and email:
  4. Librarian’s Name:
  5. Librarian’s phone and email:
  6. Number of student:
  7. Class Name & Subject:
  8. Requested date and time of visit (please list two potential dates & times):
  9. Who will accompany the students?
  10. Will you students be working on an assignment in conjunction with their visit?
  11. If so, please describe the assignment and if possible attach a copy to your request.
  12. What are your objectives for your visit? 
  13. If you have an assignment in place, what additional objectives do you have?
  14. If you would like to request borrowing privileges, in which borrowing option are you interested: high school guarantee, teacher borrowing, or courtesy card (see borrowing policies for high schools for more information)?
  15. If a phone call is required, what is the best time to reach you?

Ken Burhanna
First Year Experience Librarian
University Libraries
P.O.Box 5190
Kent, Ohio 44242-0001