Application for Guest Borrowing Privileges

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Application for Guest Borrowing Privileges

Before completing this form, please read Guest Borrower Policies.
Guest Borrowers may have up to 25 items checked out at any given time.
Please fill out all relevant sections. Items marked with an asterisk (*) are required.

Your name (Last, First, MI): *

Today's date: *

Home address: *

NOTE: You must be a resident of Addison County to qualify for guest privileges.

Phone: *

Work address:

Work phone:

Email address: *

I am a current faculty or staff requesting borrowing privileges for my child. Child's name:

I am an Alumni:

Yes

If yes, what year?:

If yes, what is your college ID number?:

Applying for: *

Borrower fees apply to Addison County residents not affiliated with the college.

3 months ($20)

1 year ($50)

Please provide a local, personal reference. Name:

Reference Address:

Reference Phone:

Local Educators:

Guest borrower fees do not apply.

School:

Principal:

Grade Level:

High School Students :

Guest borrower fees will not apply. This information will be verified by the Registrar's Office at the beginning of the semester. Borrowing privileges will be granted only for the duration of the semester.

Course:

Professor:

High School and year of graduation:

Borrowing Agreement: *

I have read Guest Borrowers Policies (linked above). I agree to abide by the policies stated therein. I understand that borrowing privileges will be revoked if the Library determines that I have abused library policies, materials, users, or staff.

I agree

Email Address:

Middlebury Libraries

Davis Family Library
110 Storrs Ave.
Middlebury College
Middlebury, VT 05753
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