State Library of Ohio - State Government

 

State Employee Patron Registration Form

All information provided is for State Library use only and will not be shared with others.

Please complete all asterisked (*) items

Contact information

* First Name  
* Last Name  

Work Information

For state employees, borrowed materials can be delivered and returned through interdepartmental mail. The following information is needed for this purpose as well as providing contact information in case there are difficulties in processing the registration or with delivery of materials.

* Work Email   * Work Phone  
Format: (nnn) nnn-nnnn
*Agency  (Select your agency from the pull-down list)
Division/Dept  
Room/Floor#  
* Street:  
* City    State:  OH
*Zip  

Home Information

Personal address information is only used in cases where a problem is encountered with delivery of requested materials and staff are unable to contact you using the information provided in the work address.

* Street:  
* City   State:  OH
*Zip  
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State Employee Registration Form
revised: 06/05

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