Kenai River Campus
Libr
Basic Information
ary Card Application
First Name: _________________________________ Middle Initial:______
Last Name: ____________________________________________________
Student ID #: ___________________________
Enter a Four Digit Pin # ___________________
Please Check One: KPC Student KPC Facult y KPC Adjunct KPC Staff Public
Mailing Address
Street: __________________________________________________ Apt#:_______
P.O. Box: _________ City: __________________ State: ______ Zip: ____________
Email: ______________________________________
Phone: _____________________________________
This card is not transferable. The signer agrees to return all material borrowed on or before the
due date and to pay the replacement cost for any materials, lost, stolen or damaged while in
the custody of the signer.
I agree to report a lost card or change of address. I agree to pay all charges on my account and
observe all library policies and use standards.
Signature: _________________________________________ Date: ______________
Office Use Only
Remarks: __________________________________________________________________________________
Date Entered: ____________ Initials: ______
Last Name: __________________________________ First Name: _________________________________
Contact Me
Read and Sign
Copy Student ID Here.
