Library Borrower Application

First Name

Last Name

Phone Number

A phone number in XXX-XXX-XXXX format is required.

Mailing Address

Where the US Postal Service delivers your mail.

City/Town

State

ZIP/Postal Code

Please indicate the type of library card you are requesting.

Student Library Card

Student ID Number

Faculty Library Card

Faculty ID Number

Staff Library Card

Staff ID Number

Community/Public Library Card

Date of Birth

Drivers License or State ID Number

Check this box if you are between the ages of 15-17.

*Parent/Guardian must have an NPC Library Borrower Card.

Name of Parent or Guardian

Parent or Guardian Signature

Sign above

STATEMENT OF RESPONSIBILITY

I agree to be responsible for material(s) borrowed and for loss and damage of such material. I understand I am responsible for notifying the library in case of loss or theft. Failure to do so will result in my being held liable for materials borrowed and for any fines incurred. Patrons are responsible to notify the library of address, email, or phone changes.

Sign Below:

Signature of Borrower

PUBLIC NOTICE OF NONDISCRIMINATION:

PUBLIC NOTICE OF NON-DISCRIMINATION: Northland Pioneer College does not discriminate on the basis of race, color, national origin, veteran status, religion, marital status, gender, age or disability in admission or access to, or treatment or employment in its educational programs or activities. District grievance procedures will be followed for compliance with Title IX and Section 504 requirements. The Affirmative Action Compliance Officer is the Chief Human Resource Officer, 2251 E. Navajo Blvd., Holbrook, Arizona 86025, (928) 524-7471. The Section 504 Compliance Officer is the Coordinator of the Office of Accessibility and Inclusion, 1611 S. Main Snowflake, AZ 85937, (928) 536-6246. The lack of English language skills will not be a barrier to admission and participation in vocational education programs.