Application

Fields marked with a red asterisk (*) or otherwise labeled are required. Please fill in as much information as possible.

Institutional Information

Name of Institution: *

Address: *

Address Line 2:

City: *

State: *

ZIP Code: *

Total Number of Students (FTE):

Required for Academic Institutions Only

Number of Undergraduate Students (FTE):

Academic Institutions Only

Number of Graduate Students (FTE):

Academic Institutions Only

Number of Faculty (FTE):

Academic Institutions Only

Total Number of Employees (FTE):

Research Institutions Only

Number of Officials, Managers, and Professional Staff (FTE):

Required for Research Institutions Only

Accreditation: *

To complete the application process, you will be asked to provide a copy of documentation as proof of your institution’s nonprofit status.

Nonprofit Tax ID Number: *

e.g. 12‑3456789

Please indicate billing address if different from above.

Billing Address:

Billing Address Line 2:

Billing City:

Billing State:

Billing ZIP Code:

Library Information

Name of Library: *

Name of Director: *

Job Title of Director: *

Email Address of Director: *

Contact Phone: *

Fax:

Library URL: *

Total Number of Library Staff (FTE):

full time equivalent number of librarians and staff members

Number of Professional Library Staff (FTE): *

librarians with a master’s degree

Number of Non-Professional Library Staff (FTE):

Number of Print Volumes in Library:

Number of Print Periodical Subscriptions:

Total Annual Materials Budget: $

Electronic Resources Budget: $

subset of materials budget, if available

Total Annual Overall Library Budget: $

including materials, salaries, and operating expenses

Library IP Address Ranges: *

OPAC Vendor:

OCLC Code:

Other Consortial Memberships:

Other Information / Notes:

Email a Copy:

Send a copy of this submission to Email Address of Director

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Application

Institutional Information

Library Information

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