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Home » Join SCELC » CSU/SCELC Resource Licensing Program

CSU/SCELC Affiliate Application

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

Affiliate Application

(program):

TexShare/SCELC Partner

ATLA/SCELC Affiliate

CSU/SCELC Affiliate

Institutional Information

Name of Institution: *

Number of Students (FTE):

* required for academic institutions only

Number of Doctoral Degrees Granted Annually (FTE):

* required for academic institutions only

Number of Faculty (FTE):

academic institutions only

Number of Researchers (FTE):

* required for non-academic research institutions only

Carnegie Classification: *

IP Address Ranges: *

Institution URL: *

Library Information

Name of Library: *

Address Line 1: *

Address Line 2:

City: *

State: *

ZIP Code: *

Library Main Phone:

Library URL: *

Billing Address Same as Above: *

Yes

No

if no, please indicate billing address below

Billing Address:

Billing Address Line 2:

Billing City:

Billing State:

Billing ZIP Code:

Number of Professional Library Staff (FTE): *

librarians with a master’s degree

Number of Non-Professional Library Staff (FTE):

Number of Volumes in Library:

Number of Periodical Subscriptions:

Total Annual Materials Budget: * $

including print and electronic resources

Total Annual Overall Library Budget: * $

including materials, salaries, and operating expenses

Fiscal Year Start Month: *

OPAC Vendor:

OCLC Code:

Other Consortial Memberships:

Special Collections:

Contact Information

Library Director

Name: *

Job Title: *

Email Address: *

Phone Number: *

Primary SCELC Contact: *

Yes

No

Electronic Resources Contact

Same as Library Director: *

Yes

No

Name:

Job Title:

Email Address:

Phone Number:

Primary SCELC Contact:

Yes

No

Access Contact

the person SCELC should communicate with regarding access to resources

Same as Library Director: *

Yes

No

Same as E-Resources Contact: *

Yes

No

Name:

Job Title:

Email Address:

Phone Number:

Primary SCELC Contact:

Yes

No

Renewal Contact

the person SCELC should communicate with regarding renewals

Same as Library Director: *

Yes

No

Same as E-Resources Contact: *

Yes

No

Same as Access Contact: *

Yes

No

Name:

Job Title:

Email Address:

Phone Number:

Primary SCELC Contact:

Yes

No

Invoice Contact

Same as Library Director: *

Yes

No

Same as E-Resources Contact: *

Yes

No

Same as Access Contact: *

Yes

No

Same as Renewal Contact: *

Yes

No

Name:

Job Title:

Email Address:

Phone Number:

Primary SCELC Contact:

Yes

No

Other Contact

Name:

Job Title:

Email Address:

Phone Number:

Primary SCELC Contact:

Yes

No

Other Information / Notes:

Submitted by Name: *

Submitted by Title: *

Submitted by E-mail: *

(program path):

texshare

atla

csu

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