The individual named above has applied for special borrowing privileges in Howard University Libraries during from ___________________ to _____________________.
          Please sign below and return this form completed to:
(name of Library)______________________________________________, certifying that the student named above is

[   ] enrolled in your school during the past academic year and is now engaged in thesis or dissertation research.
[   ] assisting in faculty research--must also obtain a letter of support from the respective faculty.
[   ] a visiting scholar.

          Your signature and school seal must be affixed below as proof of validation. By signing, you consent  to  compensate the University Libraries for library fines, the replacement costs of items not returned and considered lost or totally damaged by the said student. A student may also be liable for other costs incurred.

Name of Department Chair (Please Print) : _________________________
Signature:______________________________________

Department: ___________________________________________

Date:             ___________________________________________

Telephone No.: (_____) __________________________________

HU Email:       __________________________________________

___________________________
Department Seal