Register for Library and Learning Resources Borrowing Privileges

You may use this form to apply for borrowing privileges at Scott Memorial:

Fields marked with asterisks (*) are required.

Print this completed form and bring it, along with your photo ID, to the 2nd floor Circulation Window in the Scott Building.
Name:  *
Jefferson Campus Key (Jeffersonians only):  
Jefferson ID Badge Barcode (Jeffersonians only): (from the back of your photo ID, visitor's ID, or alumni card)
TJU Email Address:
Work/Campus Contact Information:  
Phone #: *
Building, Suite: *
Street: *
City, State, Zip: *
Home Contact Information:  
Phone #: *
Building, Suite: *
Street: *
City, State, Zip: *
Your Role at Jefferson *  
Your Jefferson School or Employer:  OR Your Affiliated Institution:
OR
Please check all that apply: *  Alumna/Alumnus

Employee - Jefferson

Employee - JMC Affiliate
   Position Title

Faculty: Department
     Paid by Jefferson
     Volunteer, JMC
     Volunteer, Other Jefferson Programs
     Emeritus

Fellow

Post-Doctoral Fellow

Resident

Student - Jefferson
     Expected graduation date

Student - Visiting / Rotation / Short-term
     Sponsoring department or contact:
     Home institution:
     Date visit ends:

Jefferson Hospital Volunteer