Library Card Application Form

							                      Library Card Application & Change of Personal Information
                                         UT Arlington Library
                                                                                                       You may be entitled to know what information The University of
•        You are responsible for reporting any change of personal information.                         Texas at Arlington (UT Arlington) collects concerning you. You may
•        You are responsible for all materials charged to your card.                                   review and have UT Arlington correct this information according to
•        You are responsible for any fines or fees incurred on your card.                              procedures set forth in UTS 139. The law is found in sections
•        You are responsible for reporting the loss or theft of your library card.                     552.021, 552.023 and 559.004 of the Texas Government Code.

Fill out this form completely. PLEASE PRINT.

Mr./Ms.:                                                                               Mav ID/DL:                                  BARCODE:
           (Last Name)                                         (First Name)

Address:                                                       ____           Apt:                                          Date of Birth:

City:                                                                                  State:                                   Zip:

Phone:                                                           E-Mail:

Indicate which applies to you:

              UTA Undergraduate Student                  UTA Graduate Student          UTA Faculty          UTA Staff              UTA Alumna/Alumnus

              UTA Intensive English Program          Other Affiliation (please specify):

              TexShare Borrower:     Home Institution:                                 Status:                                                   Minor (Under 18)

              Guest Borrower               Corporate Borrower (please specify name of business):

I agree to abide by all regulations of the UTA Library                               Signature:

                                                                                     Expiration Date:


    Date______________ Staff Initials __________ Voyager                                           Q:\....circulation service desk\forms\libcardapp2008revision.DOC




                      Library Card Application & Change of Personal Information
                                         UT Arlington Library
                                                                                                       You may be entitled to know what information The University of
•        You are responsible for reporting any change of personal information.                         Texas at Arlington (UT Arlington) collects concerning you. You may
•        You are responsible for all materials charged to your card.                                   review and have UT Arlington correct this information according to
•        You are responsible for any fines or fees incurred on your card.                              procedures set forth in UTS 139. The law is found in sections
•        You are responsible for reporting the loss or theft of your library card.                     552.021, 552.023 and 559.004 of the Texas Government Code.

Fill out this form completely. PLEASE PRINT.

Mr./Ms.:                                                                               MavID/DL:                                   BARCODE:
           (Last Name)                                         (First Name)

Address:                                                       ____           Apt:                                          Date of Birth:

City:                                                                                  State:                                   Zip:

Phone:                                                           E-Mail:

Indicate which applies to you:

              UTA Undergraduate Student                  UTA Graduate Student          UTA Faculty          UTA Staff              UTA Alumna/Alumnus

              UTA Intensive English Program          Other Affiliation (please specify):

              TexShare Borrower:     Home Institution:                                 Status:                      ______________            Minor (Under 18)

              Guest Borrower               Corporate Borrower (please specify name of business):

I agree to abide by all regulations of the UTA Library                               Signature:

                                                                                     Expiration Date:


    Date______________ Staff Initials __________ Voyager                                           Q:\....circulation service desk\forms\libcardapp2008revision.DOC