Name:____________________________________________________
Date:_________________
Local address:_____________________________________________
_______________________________Telephone:_________________
Permanent address:_________________________________________
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Student status or occupation:__________________________________
Institutional Affiliation:___________________________________________________________________
Subject of research (please be specific: included dates, proper names, etc.)__________________________
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How did you hear about our holdings?_______________________________________________________
What is your Armstrong affiliation?
( ) Armstrong undergraduate
( ) Armstrong graduate student
( ) Armstrong faculty/staff
( ) Armstrong Alumni
( ) Visiting researcher
Purpose of research (check all that apply):
( ) Class assignment ( ) M.A. Thesis
( ) Family history
( ) Honors Paper/Senior Thesis ( ) Ph.D. Dissertation
( ) Local history
( ) Graduate/Seminar Paper ( ) Exhibit
( ) Pictorial research
(..) Armstrong history ( ) Article (
) Personal Interest
(..) Administrative Use ( ) Book
( ) Other_____________
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Data from this form will be used to compile statistical and research topic summaries. We attempt to inform researchers of others with similar interests. Do you object to having your name and information about your research topic made available to others working in the same area? Yes ( ) No ( )
I HAVE READ, I UNDERSTAND, AND I AGREE TO ABIDE BY THE RULES FOR USING THE ARCHIVES.
Signature:_______________________________ Date:_______________________________