Request for Re-Instatement of Internet Privileges

 

To be filled out by Branch Manager:

What was the patronís first violation of Internet Rules and Regulations?Be precise:†† __________________________________________________________________________________________________________________________________________________________________________

Date violation entered on patronís account: ___________________________

 

What was the patronís second violation (s) of Internet Rules and Regulations?Be precise:

_________________________________________________________________________________________________________________________________________________________________________

Date violation entered on patronís account: ___________________________

Additional comments may be made on back of form if necessary.

 

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(Bottom portion to be filled out by patron requesting re-instatement of Internet privileges)

 

Patron Name:______________________________ Date: ________________________

 

Contact number: ___________________________ Library Card Number: __________________

 

Did you read the Internet Rules and Regulations and sign the Internet Rules and Regulations Internet Agreement form?Yes___††††††††††† No___

 

Do you understand why your Internet privileges were suspended?__________________________________________________________________________________________________________________________________________________________________________

Why should your internet privileges be re-instated?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Additional comments may be made on back of form if necessary.