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Distance Learning Services - Library Card Application

This application is for students who are ONLY enrolled in Distance Learning courses and cannot visit a campus library.

( * = required field in form below)

Please provide the following information:CCRI barcode:Home address:Mailing address (if different from home address):Note: Students under age 18 must have a perent or guardian sign this form.If under 18 years of age:

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Last Updated: 8/18/16