Distance Learning Services - Library Card Application

This application is for students who are ONLY enrolled in Distance Learning courses and cannot visit a campus library.

Library card activation is for the borrowing of physical materials from the library. Due to the COVID-19 pandemic, the libraries are closed and physical materials are not being lent. To access online resources please use your CCRI username and password. The same one that is used to log into Blackboard and CCRI email.

( * = required field in form below)

Please provide the following information:

First name: *

Middle name:

Last name: *

CCRI ID number: *

CCRI barcode:

Your CCRI barcode number is the 14-digit number just below the barcode strip on your CCRI ID card. Skip this field if you do not have a CCRI ID card.

Email address (CCRI email preferred): *

Alternate email address:

Phone number: *

Home address:

Street: *

City: *

State:

Zip: *

Mailing address (if different from home address):

Street:

City:

State:

Zip:

Distance Learning course(s) enrolled in:

Note: Students under age 18 must have a parent or guardian sign this form.

Age:

Under 18 years of age

18 years of age or older

I agree ...

to abide by the rules and regulations of the CCRI library and to be responsible for material checked out to me.I understand that failure to return materials borrowed may result in a $75 fee per item, the loss of library privileges and the withholding of grades, transcripts, diplomas, and or registration for classes.

Please type your name to act as your signature: *

If under 18 years of age:

Parent/guardian signature:

Parent/guardian email address:

Comments:

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This page developed and maintained by the CCRI Library. Send comments and suggestions to [email protected].

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