Educational Library Access Request Form
Request permission to access the educational library and its resources by completing this form.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Affiliation/Status
*
Please Select
Undergraduate Student
Graduate Student
Faculty/Staff
Researcher
Visitor
Other
Institution/Department
*
Student/Staff ID Number (if applicable)
Purpose of Library Access
*
Academic Research
Coursework/Study
Teaching/Instruction
Personal Development
Other (please specify)
Resources You Intend to Use
*
Books
Journals/Magazines
Digital Resources/Databases
Study Rooms
Computers/Equipment
Other
Preferred Access Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preferred Access End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please specify any special accommodations or accessibility needs (optional)
Signature (please sign below to confirm your request and agreement)
*
Submit Request
Submit Request
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