Application for MG Card (Library ID Card) Issuance
To: Head Librarian, Meiji Gakuin University LibraryI would like to apply for my “MG card” and “MyLibrary password” per the details provided below.
The personal information provided in this form will only be used for the purposes required for library use.
Information will be handled according to “Meiji Gakuin University Protecting Personal Information Policy”.

1. Please fill out the details inside this bold frame.

(YYYY/MM/DD)

Date appliedApplication□ New applicationcategory□ Renewal (do not have MG card）//□ Renewal (have MG card)□ Lost during period of validity
NameKana(Please write the Japanese syllabary if possible.)*not compulsory
Address

Post code(Address in Japan)
Tel図□書
身館分処
証理
・欄
現①住所
を確
認し、
該
当
身分にチ
ェ
ック→
該
当の太枠に記
入をお願いする(You may give your mobile phone number .)e-mail(You may give either your university e-mail or your private/mobile phone e-mail.)Preferred place toreceive□ Shirokane Library□ Yokohama Library

2. Please fill out the details inside the bold frame next to the checked box.

□1.Part-time lecturer/ research user
大学非常勤講師・研究利用者□2. Emeritus professor
名誉教授□3. Yamanote Line
Private University
Library Consortium

Faculty, etc. *Please encircle the appropriate faculty.
Letters, Economics, Sociology, Law, International Studies, Psychology,→ Mathematical Informatics, Liberal Arts, Graduate School, Other ()MAIN ID/Academic Affairs WebServices ID ()→ Faculty/department at time of retirement ()Affiliated university/student No.

→ (* Expiry date of ID/Student card____/__/__(YYYY/MM/DD))

山手線コンソーシアム□4. Graduate or Master’sand Doctor’s degree
holder (including those
who have fulfilled courserequirements)
卒業生・修了生（満期退学者も含む）□5. Academic societycollaboration
学協会連携□6. Student of Challenge
Community College
チャレンジコミュニテ
ィ在学生

Alumni Association member no. (A 会員番号)→ (/Former student no.

)

Historical Society of English Studies in Japan /→ Japanese Association of Psychiatric Social Workers
Name of department 所属部署名→ Name of Supervisors 所属長名

社会連携課
(stamp*印)

□7. One who completed
Challenge Community
College→ * Date completed: ____/__/__(YYYY/MM/DD)

チャレンジコミュニテ
ィ修了生□8.Registered researcher研究登録者

Period of service*在職期間 ____/__/__ to→ (Longest: End of academic year)* Not required if full-time teacher at Junior/Senior High School□9. Registered in school
学内登録者

Name of department 所属部署名
Name of Supervisor 所属長名

□Temporary
staff/Contractor/CasualEmployee
派遣・委託・アルバイト□ Junior/senior high school,
full-time teacher 中高専任
□Junior/senior high school,
part-time teacher 中高非常勤□10. Former employee
元専任教職員→□12. Corporate, otheremployees
法人等勤務員(stamp*印)* Stamp of supervisor not required if in possession of the following:□ Teaching Staff ID (full-time teacher at Junior/senior high school)□ ID from school’s Personnel Department (part-time teacher at Junior/SeniorHigh School)→Faculty/department at time of retirement□11. Former part-timelecturer◆* Those with continuous
employment for at least 10years
元非常勤講師 *勤続 10 年
以上の方____/__/__ (YYYY/MM/DD)(→)

Date of employment____/__ Date of retirement____/__(YYYY/MM)→ □ Corporate Director□ Corporate Auditor □ Councilor□ Visiting Professor

3. Please describe the purpose of use (only those with ◆ marks)Purpose of use: (example) To gather materials for researching ○○