國立成功大學圖書館珍貴資料調閱申請單
The Application Form for Using National Cheng Kung University Library Special Collections

姓名
Name
  
 教職員工生證號/
身分證字號(校外)
ID number
  
 系所（單位）
Dept.
  
電話或手機
Tel.
  
   Email： 申請日期
Date
  2023-03-24
No. 索書號
Call no.		 登錄號
Item Barcode		 書名
Title
1
2
3
4
5
6
7
8
9
10

注意事項(Notes)：

  1. 填寫後請送交本館5樓典藏組辦公室或1樓流通櫃台。經本館核定後，通知申請人於保留期限內洽典藏組調閱使用。
    This form shall be sent to the Collection Management Division office on the 5th floor or the circulation counter on the 1st floor. Once approved, the applicant will be notified by the Collection Management Division to use the items within the retention period.
  2. 調閱使用時間：本校上班日週一至週五9:30-16:30。限於指定地點閱覽使用，調閱資料至遲須於使用時間結束前洽本館典藏組辦理歸還手續。
    The applicant may access the approved items from 9:30 to16:30 on Monday to Friday within the retention period; the items must be used at designated location and returned to the Collection Management Division by 16:30 of the day.
  3. 保留期限：每一申請件經核定後，自本館通知次日起保留3天（不含例假日）為原則，逾時未取以棄權論。
    After each application has been approved, the retention period is 3 days (excluding holidays) from the next day after being notified by the Library; if failed to access the materials before the deadline, it is considered waiver of right.
  4. 調閱冊數：每次之調閱冊數以10冊(件)為限。
    The number of items to be requested each application is limited to 10.
  5. 凡通過調閱申請者，須憑本校識別證、學生證、身分證、駕照、健保卡、教師證、護照等足以證明個人身分之有效證件，始得提閱。
    All applicants who are approved to access of special collections must bring valid certificates such as the NCKU ID card, student ID card, national ID card, driver’s license, health insurance card, teacher’s license, passport to prove your personal identity.
  6. 凡欲重製珍貴資料者，限以相機、手機等與攝影有關之器材翻拍，不得影印或以其他有損原件之方式重製，並應遵守著作權法相關規定。
    Anyone who wishes to photocopy the items shall be limited to using cameras, mobile phones and other equipment related to photography, and shall not be photocopied or reproduced in other ways that impair the originals, and shall comply with the relevant legislation on copyright and data protection.
  7. 讀者使用調閱資料時，須對珍貴資料慎加愛護，並遵守「國立成功大學圖書館珍貴資料使用服務要點」之規範。
    Patrons must take care when handling the special collections materials and should comply with “National Cheng Kung University Library Guidelines for Use of Special Collections”.
  8. 業務聯絡電話：校內分機 65753（典藏組）。
    If any problem, please contact Collection Management Division, 2757575 ext.65753.

本表單所蒐集之個人資料，係基於圖書館管理需求之特定目的而蒐集，將用於辦理成大圖書館珍貴資料調閱業務之處理與利用，蒐集之資料將依個人資料保護法相關規定處理。當您填寫本表單之個人資料時，即視為您已瞭解上述相關內容，並同意本館蒐集、處理及利用您的個人資料。

Your personal data written in this form will be collected to meet the needs of library administration and used to handle the services for using special collections by NCKU Library. Your personal data will be used under the constraint of Personal Data Protection Act, and NCKU Library issues its statement of personal data protection and collection agreement to notify you of your responsibilities and rights and solicit your consent to the collection, processing and use of your personal data by NCKU. Your submission of this application form indicates that you have read, understood and accepted the contents set forth above.