Form 14003 Researcher Application

OMB Control No. 3095-0016

Expiration date: 11-30-20XX

RESEARCHER APPLICATION

Type of Application New Renewal

See the back of this form for the Privacy Act Notice that applies to the information you provide below.

Applicant’s name (First, Middle Initial, Last) Please indicate Mr. Mrs. Miss Ms.

     

Permanent address (Street, City, State, Zip Code, Country) Home telephone number

           

Local address (Street, City, State, Zip Code) Mobile number

           

E-mail address

     

Optional – this information is not required for obtaining an identification card – it would aid our staff in assisting your research:

Share the subject of your research with others? Yes No | Connect you with researchers of similar subjects? Yes No

Check all that apply:

Genealogist Scholar/Academic Journalist/Media Student Government Lawyer

Other (specify)      

Check all that apply:

Family History Senior Thesis Master Thesis Article Film/TV Legal

Course paper Book PhD dissertation Other (specify)      

Description of proposed research (identify topic specifically, e.g., date span, research area, full name of biographical subject, etc.):

     

Tentative title:       URL of Research Project:      

Name of instructor:      

Name and address of employer or institution:       Occupation:      

Check here if you do want to be on a mailing list to receive information on NARA events, programs, publications,

and invitations to join and contribute to NARA-associated foundations.

I will comply with all regulations regarding the public use of records at the National Archives and Records Administration (36 CFR Part 1254), as summarized on the back of this form.

Applicant’s signature

Date

FOR NARA USE ONLY

Identification (example: driver’s license, student ID, passport, company ID, etc.)	Comments
Signature and title of approving official		Date	Card No.	Wireless account No.

RESEARCH ROOM RULES

(for complete Research Room rules, see 36 CFR Part 1254)

What Not to Bring: Researchers may not bring into most research rooms: overcoats, raincoats, hats, or similar apparel; brief cases, suitcases, daypacks, purses, or similar containers for personal property; notebooks, notepapers, note cards, folders and other containers for papers not essential to the researcher’s work requirements. These personal items should be stored in lockers or other storage facilities conveniently located outside research rooms and must be removed each night.

What to Bring: Personal computers, tape recorders, hand-held cameras, other audio-visual equipment, and typewriters may be brought into the research room only after inspection and only if their use will not disturb other researchers. Scanners must meet NARA requirements and can only be used where permitted and in designated areas. Drum and automatic feeder scanners are prohibited. Hand-held wallets and coin purses for carrying currency, coins, credit cards, keys, drivers’ licenses and other identification cards may be brought into the research rooms. Notes, references, lists of records to be consulted, and other materials may be admitted if they are essential to the researcher’s work. All equipment, personal possessions, and documentary materials are subject to inspection when the researcher enters or leaves the research room. More information is available at http://www.archives.gov/research/start/whats-allowed.html

Researchers must exercise all possible care to prevent damage to the records. Records must not be leaned on, written on, folded anew, traced, or handled in any way likely to cause damage. Only one box or one folder of loose paper may be opened at any time. Eating, smoking, drinking, loud talking or other activities likely to disturb other researchers are prohibited in research rooms.

Failure to abide by these rules may result in the revocation of the researcher identification card.

HOW YOUR INFORMATION IS USED

In compliance with the Privacy Act of 1974, the following information is provided:

Solicitation of the information is authorized by 44 U.S.C. 2104. Disclosure of the information is voluntary; however, the effect of not providing the information is that a researcher identification card will not be issued to the individual. A researcher identification card is required for research (other than microfilm records).

The information provided will be used to identify and record individuals who use records in the National Archives, regional records services facilities, and Presidential libraries, to determine records that the individual should use, to enable later contact with the individual if additional information is found or if problems with the records are discovered, and to mail notices of events and programs of interest to users of the records and invitations to participate in customer satisfaction surveys.

The information may be transferred to appropriate Federal, State, local, or foreign agencies when relevant to civil, criminal, or regulatory investigations or prosecutions; the information may be disclosed by NARA to an expert, consultant, or a contractor of NARA to the extent necessary for them to assist NARA in the performance of its duties; the information may be disclosed to the U.S. Department of Justice or to a court or adjudicative body in cases involving the mutilation or unlawful removal of the records.

PAPERWORK REDUCTION ACT PUBLIC BURDEN STATEMENT

The information requested on this form is being collected and used by NARA in order to screen individuals, to identify which types of records they should use, and to allow further contact. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Public burden reporting for this collection of information is estimated to be 8 minutes per response. Send comments regarding the burden estimate or any other aspect of the collection of information, including suggestions for reducing this burden, to National Archives and Records Administration (ISP), 8601 Adelphi Road, College Park, MD 20740-6001. DO NOT SEND COMPLETED FORMS TO THIS ADDRESS.

NATIONAL ARCHIVES AND RECORDS ADMINISTRATION NA Form 14003 FRONT (10-11)