Faculty member's name:_________________________________________

Department:____________________________________________________

Student's name:________________________________________________

Student will be working for me until:__________________________

As a faculty member applying for a student assistant card,
I accept all responsibility for any use of this card,
including fees and bills for lost items.

Faculty Signature:___________________________________Phone#:____________

Email:__________________________________________________________________

As a student assistant, I understand that this card is only to be used
for library transactions on behalf of the faculty member who has applied
for the card.

Student Signature:______________________________________________________

Exp date_________________ Approved_____________ Sent__________

UNIV ID:___________________________________