Patron Information Form

Patron Information Form

WU Special Collections researchers should complete this form once per academic year. If you have any questions or difficulties, please email spec@wumail.wustl.edu.

Date Submitted

Patron Name (Last Name, First Name)*

Pronouns

Street Address*

Apartment#

City*

State*

Postal Code*

Country (If not U.S.)

Patron Email*

Phone*

Notes-Other Information

Purpose of Research*

Select

Affiliation*

Select

Other Affiliation Note

Collection(s) and/or Subject Area(s)

Please list the collection(s) or subject areas you are interested in accessing.

Research Appointments

Previous Visit

Have you previously visited Special Collections or been in contact with a curator or staff member?

Select or enter value

Spec Contact

If you have been in contact with a curator or staff member, please add their name.

Reading Room Appointment

Would you like to make a research appointment?

Research visits to the Julian Edison Department of Special Collections at both Olin and West Campus are by appointment only. Staff require a minimum of three business days to coordinate requests.

Please note the Dowd Illustration Research Archive and the Film and Media Archive collections are served at West Campus. All other materials are housed in Olin Library.

Select or enter value

Preferred Date-Time - First choice

Preferred Date-Time - Second choice

Preferred Date-Time - Third choice

Requesting Materials and Reproductions

Paging Form

Do you know what materials you would like to view?

Select or enter value

Requesting Reproductions

Would you like to request reproductions?

Select or enter value

File Upload

If you would you like to request reproductions, please download and complete the Request for Reproduction Form (PDF) and upload it as an attachment.

If you know what material you would like to see during your appointment, please download and complete the Paging Form (PDF) and upload it as an attachment. Researchers can fill out the Paging Request Form to have materials retrieved from storage for use in the reading room. As a general guideline, you can request up to 6 boxes or 6 books for each day you plan to visit. Please contact the staff if you have extenuating circumstances regarding your visit (international travel, etc).

You can upload one or two files here.

Drag and drop files here or

Accommodations

Do you need any accommodations to do research in Special Collections?

Select

If you need accommodations, please add details here.

Signature and Statement of Responsibility

Signature*

Statement of Responsibility

By typing my name and checking the Confirmation Box, I certify that the information on this form is correct and that I have read and agree to abide by the rules and procedures set forth in the Material Use Policies. I further agree to defend and hold harmless Washington University, its Washington University Libraries and Department of Special Collections, its Board of Trustees, and its Officers, Employees, and Agents against all claims, demands, costs, and expenses including attorneys' fees incurred for any and all claims of copyright infringement or any other legal or regulatory cause of action arising from my use of Special Collections materials.

Confirmation*

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