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Authorization Form for Library Material Delivery to Off-Campus Students

By submitting this form, I authorize Libraries staff to check out materials in my name and ship them to the street address provided below (No P.O. Boxes, please!).  I agree to update this information by submitting another form if my address changes.  I agree to return materials at my own expense, using a shipping service with package tracking.  I accept responsibility for all materials checked out in my name and am responsible for the loss of any materials returned to the library using a shipping service without package tracking and insurance.  I am a Kent State University student or faculty living 30 or more miles from any Kent State University Library (Kent Campus or Regional Campuses), and I do not attend classes on any campus.

 

Name This field is required
Address line 1 This field is required
Address line 2
City This field is required
State  This field is required
Zip code
Numerical digits onlyThis field is required
Home phone number  This field is required
Academic department or major   
Kent State email address This field is required
   
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