Application form

Data Protection: personal data supplied by you will be used only for the purposes of
administering the scheme, including the transfer of data between home and host
libraries and vice versa. The information provided here is essential to your application.

Please complete clearly in BLOCK CAPITALS. Thank you.

Surname / Family name ……………………………………....................................

First Name(s) ……………………………………………………………………………

Contact email ……………………………………………………………………………

Please supply an email address where we can contact you if there are any queries about your application.

Library / ID card number (home institution) ………………………………………….

Please circle the appropriate categories from both 1 and 2 below:

1. Staff / post graduate research student / taught postgraduate / undergraduate

2. Full-time / part-time / distance learner / placement

To be eligible for SCONUL Access you must

• Be a registered library user at a home university or college which supports your

type of user.
• Be considered “in good standing” (i.e. have abided by the library rules, paid
library debts etc.)

I agree to be bound by the rules and regulations of all the libraries I apply for and / or
use

Signature ………………………………………….. ………. Date.........................

Authorisation: to be completed by library staff

Applicant’s library / ID card expiry date ………………………………………………..

SCONUL Access card expiry date ……………………………………………………..

Band of User ……………………………………………………………………………..

Library Staff name ………………………………………………………………………..

Library staff signature ……………………………………….. Date …………………….

Form to be retained by home institution March 2008