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Application for a Borrower's Card


(Complete this form if you are not UMass or 4 College Faculty, students & Staff)

* New    Renewal

*Last Name: *First Name: Middle Initial:

*Email: (If you don't have an email address, leave the default address)

*Current Mailing Address
(Street) (City)
(State)

(Zip Code)

(Phone)
Home Address (If different from Mailing Address)
(Street) (City)
(State)

(Zip Code)

(Phone)

*Status: Please Select One:

Alumna / Alumnus    Year of Graduation

Student Currently Enrolled in an Academic Institution.    School Name
This is a:     College/University   Secondary/High School
( Under 18 yrs. of age: A letter signed by the High School Principal or School Librarian is required.)

Visiting Faculty/Research Scholar     Department
(Verification of employment or letter from Department required)

From: To:
  (Month/Year)   (Month/Year)



                               

Short Term UMass Sponsored Program Name
(Letter from Department Required)

From: To:
  (Month/Year)   (Month/Year)


 

Massachusetts State Resident

Other

Personal Agreement: I agree to abide by the Rules & Regulations of the UMass Amherst Library System and assume responsibility for replacing any lost or damaged material. I acknowledge that the Library Borrower's Card is the property of the University of Massachusetts Amherst Library and I agree to return it upon request.

* I have read and agree to the Personal Agreement.

Please present a photo ID when picking up your Library Card.

*Please select a pick-up location:
    

Lost or stolen cards should be reported immediately.

* Required Fields