Library Card Application

Last Name ______________________First Name _____________Middle Initial ______
Home Address: ____________________________________________________________
City ____________________________State _________Zip_______
Email Address:______________________________________________________________
Home Phone No.(______)____________ Business Phone No. (______)______________

Students:

Program of Study/Major:  _______________________________________________

Student ID #:  __________________________________________________________

	NVCC Student
	NVCC Distance Learning Student
	NVCC Danbury Campus
	NVCC Temp Student
	Teikyo Post University
	UCONN Student
	WCSU Student
	SCSU Student
	CCSU Student
	ECSU Student
	Charter Oak Student
	Student from other institution
	Name of the Institution:

Faculty / Staff / Public Borrower:

NVCC Faculty         full-time        part-time   Dept & Office No.: _______________
NVCC Staff       full-time       part-time Dept & Office No.:_____________________
Public Borrower:__________________________________________________________ Faculty/Staff from other institution Name of institution:______________________

I agree to comply with all regulations of the NVCC Learning Resource Center including the obligation to return all materials promptly and/or pay for any damage. I understand failing to do so may prevent me from registering and receiving an official transcript. I also will promptly notify the NVCC LRC of any change in name, address or phone number.

Signature:  _______________________________  Date:  _________________________

**Please be prepared with photo id and student id card, when you come to the library to pick up your library barcode. If you are a distance learning student and are unable to come to the library, we will process your application via email within 48 hours.