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 address provided below. 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 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