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University Archives: Patron Use Request/Registration Form

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Administrative Responsibility | Collection Policy | Disposal of Materials | Exhibition Guidelines | History | Patron Use Request Form | Patron Use Guidelines | Use of Materials | Archives Home

Use the request form to obtain permission to use Xavier University Library archives or special collections.

Please read the Xavier University Library Archives & Special Collections Guidelines before completing this form.

Name:
Email:
Address:
Home Phone:
Work Phone:
Date:
Status:
If you are a Xavier affiliated patron, please indicate your status from the selections below.

Undergraduate
Graduate
Faculty/Staff
Alumni
Character Reference:
If you are a non-Xavier affiliated patron, please provide one character reference. This reference should be from an educational institution, place of employment, library or professional organization.


Character Reference Name


Character Reference Organization, etc.


Character Reference Address


Character Reference Phone
Guidelines:
I have been provided with a copy of Xavier University Library Archives & Special Collections Guidelines. I have read these guidelines, understand them and agree to follow them.
Yes:     No:

Research Interest:
Please state the nature and proposed application of your research; e.g. journal article, dissertation, term paper, etc. Include any information that would be helpful in describing your research question. Indicate when your research must be completed.

I agree that if I choose to publish any material, in any format, from the Xavier University Library Archives' collections, now or later, I will abide by the following conditions:

  1. The source must be acknowledged in the work with the credit line "Xavier University (Cincinnati, Ohio) Archives."
  2. I realize that I am responsible for conforming to copyright, right-to-privacy, libel, slander and any other applicable federal and state statutes. I agree to indemnify and hold harmless Xavier University, its officers, employees and agents from any and all claims resulting from the use of the materials. I understand that failure to comply with these rules may result in the denial of access to the collections in the future.

Yes:     No:

 

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