New Reading Room Form with Logic

Kilby Reading Room Registration Form
Name:*

First NameLast Name
Email:*
example@example.com
Form Type:
Blank Space!
Form Type:
Blank Space!
Form Type:
Blank Space!
Form Type:
Blank Space!
Form Type:
I am...*

A Wheaton College community member (current student, faculty, or staff)A visitor, here for personal enrichmentA researcher, employing a proxyA visitor, here for academic research (above the undergraduate level)Enrolled in the Wade Center Continuing Scholars Program
Name of Proxy Researcher (if known):

First NameLast Name
Proxy Research on behalf of:*

First NameLast Name
Total Number of Visitors (Including You):*
Only visitors who share the same address may use the same form
Additional Visitor Names:
Address:

Street Address

Street Address Line 2

CityRegion (if outside US or Canada)

Postal/Zip Code
Country:
State:
Province
State/Region/Province

Street Address

Street Address Line 2

City

Postal / Zip Code
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Wheaton College Role:*

Undergraduate StudentStaffGraduate StudentFacultyWheaton College Summer Institute
Department/Major:
Student ID (if applicable):
Date and Time of Visit
Date of Visit:
On/From: *

MonthDayYear
First (or only) date of visit
To:

MonthDayYear
Leave blank if you are only here for the day specified above.
Estimated Time of Arrival (9am to 4pm only):

Hours Minutes

AM/PM Option
Purpose of Visit
Reason for Visit (choose the option that best applies):*

ClassProxy ResearchHonors Thesis / Thesis / DissertationOther (please specify)PublicationPersonal Interest
Proxy Research on behalf of:*

First NameLast Name
Reason for Visit:
Class Professor:
Course Number (or title):
Author(s) of Interest (select any that apply):

C.S. LewisJ.R.R. TolkienDorothy L. SayersGeorge MacDonaldG.K. ChestertonCharles WilliamsOwen BarfieldOther (please specify)
Other:
Topic(s):
Research Topic:*
Affiliation:*

InstitutionIndependent ScholarOther (please specify)
Affiliated Institution Name:*
(if applicable)
Other Affiliation:
Institutional Role:

Graduate StudentFacultyStaffOther (please specify)
Other Role:
Department:
What Graduate Degree Are You Pursuing?
Ex: M.A., Ph.D., M.Div., Psy.D., etc.
Research Questions/Area of Study:*
Is your research project intended for publication?

YesNo
Proposed Title of Publication:
*Expected Date of Publication:
*or date of completion for theses/dissertations
User Agreement
The Marion E. Wade Center permanently retains all data provided on this form, as well as records pertaining to requested materials. This data is only accessible by Wade Center staff.
I agree that typing my name constitutes my digital signature:*

First NameLast Name
Form Date:

MonthDayYear
Today's Date
Please add me to the Wade Center email list for news and events
Should be Empty:

Kilby Reading Room Registration Form

Date and Time of Visit

Purpose of Visit

User Agreement