Library Card Application

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

Students (check one):

Program of Study/Major:  _______________________________________________

Student ID #:  __________________________________________________________

	NVCC Student        Full-time ____     Part-time___
	NVCC Distance Learning Student         Full-time ___    Part-time___
	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 (check one):

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.