Part 1: Patron Information

Last Name: First Name:

Patron Number: Email address:

Office or Residential Address:

City: State: Zip:

Home Phone: Work Phone:

Fax Number:

User Status (check one): Student Faculty Staff

Local patrons must pick up items at the library.  Distance education patrons must cloose a delivery method: Delivery method and location (check one): U.S. mail Fax to number specified above

Part 2: Item Information Complete ONE of the following two boxes (One item per request, please)
PERIODICAL ARTICLES & ERIC DOCUMENTS ONLY Author (last, first): Article Title: Periodical Title: Volume Number: Issue Number: Pub. Date/Year: Page numbers: ERIC Document (ED) Number (if applicable):	BOOKS & VIDEOS ONLY Author (last, first): Book/Video Title: Publisher: Year: Edition:
Where did you find the above information? Is this item held by the AU main library? Yes No Item not needed after this date: Additional notes:

Part 3: Warning Concerning Copyright Restrictions The copyright law of the United States (Title 17, United States Code) governs the making of photocopies or other reproductions of copyrighted material. Under certain conditions specified in the law, libraries and archives are authorized to furnish a photocophy or other reproduction. One of the specified conditions is that the photocopy or reproduction is not to be "used for any purpose other than private study, scholarship, or research." If a user makes a request for, or later uses, a photocopy or reproduction for purposes in excess of "fair use," that user may be libable for copyright infringement. This institution reserves the right to refuse to accept a copying order, if in its judgement, fulfillment of the order would involve a violation of copyright law. I have read and agree to abide by these copyright restrictions (click box)