02/14/14
The Fales Library & Special Collections
Reader’s Application
Name:
(please print)
Permanent Address:
Phone:
E-Mail:
Institutional Affiliation:
Academic classification:
Faculty
Graduate student
Undergraduate student
Independent scholar
Describe fully the subject, scope, and purpose of research:
Type of material requested:
printed material (books & periodicals)
archives
Activity:
examine materials and take notes for research
consult interlibrary loan materials
photograph collection materials [with prior permission only]
identify materials for an exhibition loan
request copies or scans
other [Please explain]:
I intend my research to result in:
article
book
thesis
dissertation
project for a course
conference paper/presentation
exhibition
creative project
documentary film
other [Please explain]:
The Fales Library Special Collections may reveal my name and the subject of my research in its publications
and to other researchers working or planning to work on related topics. Please indicate “yes” or “no” and
initial.
Yes No _________
(Continued on back)
02/14/14
Agreement:
I have read and understand the rules and policies of the Fales Library & Special Collections as set forth in the
“Rules and Procedures” and, by my signature below, agree to abide by them. I understand that in the event I do not
adhere to these rules and policies, my privileges as a reader may be revoked.
________________________________________________
_________________
Signature
Date
Please return the original of this form to the Reference Librarian. Fales Library & Special Collections, New York
University, 70 Washington Square South, 3
rd
floor, New York, NY 10012.
For Fales Use Only:
Curator__________
