Archives and Special Collections

    North Park University Library 

Institution Requesting Transfer: ___________________________________________

Department/Office:________________________________________________

 Statement of Representation/Person Authorizing Transfer: _____________

__________________________________________________________________

Address: _________________________________________________________

Phone: ___________________________________________________________

Signature: ___________________________________Date: ________________

Description of Records: 

 

Span Dates of Records:  __________________________________________________

Estimated Volume: ______________________________________________________

Notes Concerning Disposition:

 

Restrictions on Access and Use (each with event or date of release):

______________________________________________________________________________

Archives Staff acknowledging Receipt of Records:  __________________________

Position Title _____________________________________________________

Date_____________________________________________________________

Accession # ____________________________________________________________