Research Assistant Form

We are pleased to offer this service which will allow you to have one other person charge Library material out for you.

We will renew this privilege on a semester-by-semester basis, should you require it.

Please note that we are creating a second record on our database. This second record will not be automatically updated when you submit a name and/or mail address and/or email address change on your original record - please ask Library staff to separately make any necessary changes to this record.

Please fill in the authorization below.

I hereby authorize __________________________________________to charge out Library material on my behalf for the ___________ 20____ semester. I understand that all notices (recall, hold available, overdue, etc.) will be sent to the address given below and that I will be responsible for ensuring that all materials are returned to the Library when due.

I further undertake any indebtedness resulting from overdue or lost books.

Faculty Name:__________________________ Department:____________________ Phone:(____)_________________
(Please print)
____________________________________________________ Date:____________________
(Signature)

Contact Information: (Note - mailing defaults to email if given below)

email: Faculty member:____________________________and Research Ass't:____________________________

(Note- notices will go to both email contacts)

Home address: ___________________________________________________________
(street)
  ___________________________________ ________________
(city)
(postal code)

Staff Use Only

__________application complete?

__________Card prepared and signed?

__________Loans Policy given? staff signature _______________________