College Now Instructor App for Library Privileges

SMSU Library
College Now Instructor – Application for Library Privileges

Last Name:___________________________________First Name:___________________M.I.______
 

Drivers License #: _________________________________________________________
 

Home Address: Street:_____________________________________________________
 

City:________________________State:________Zip Code:___________________
 

Telephone Number:_____-_____-_____
 

E-mail:____________________________________________________________________
 

School name:_______________________________________________________
 

I accept responsibility for materials borrowed and understand that I must pay for all materials which are lost, damaged, and/or not returned, as well as a $10 fee for each item that is lost, damaged, not returned and/or overdue.

_________________________________________________ _____________________________
Signature                                                                         Date
 

_________ I verify that I am 18 years of age or older.