West Virginia Library Commission Home > State Employee Library Card Request Form

State Employee Library Card Request Form

This form is for West Virginia state employees only. Please call the library at (304) 558.2045 to learn how residents may apply for a state library card.

All required fields are indicated with an asterisk “*”.

First Name:

Middle Initial:

Last Name:

Agency/Department:

Bureau/University name/Other

Office Address:

City:

Zip code:

Work Phone:

Work E-mail:

Home Address:

City:

Zip code:

Home Phone:

Applicant is responsible for fees, damage to, or loss of materials charged to card and will notify the library of address change or card loss.
Select “Yes” to agree to this statement of responsibility.*

Yes

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State Employee Library Card Request Form

First Name:

Middle Initial:

Last Name:

Agency/Department:

Bureau/University name/Other

Office Address:

City:

Zip code:

Work Phone:

Work E-mail:

Home Address:

City:

Zip code:

Home Phone:

Applicant is responsible for fees, damage to, or loss of materials charged to card and will notify the library of address change or card loss.Select “Yes” to agree to this statement of responsibility.*

Applicant is responsible for fees, damage to, or loss of materials charged to card and will notify the library of address change or card loss.
Select “Yes” to agree to this statement of responsibility.*