2. First Name*
3. Last Name*
5. Address1*
7. Address2
9. City*
10. State*
11. Zip*
13. Date of Birth*
    Date of Birth
14. Email Address*
16. Preferred Method of Contact*

    1. Phone
    2. Email
17. Phone Number*
19. ID Type*

    1. Texas Driver's License
    2. Texas State ID Card
    3. Matriculation ID
    4. Passport
    5. LDISD ID Card
    6. Other State ID
20. ID Number*
22. Would You Like to Register to Vote? *

    1. Yes
    2. No
24. Photo Identification*
    Please provide a scanned photograph or PDF of your photo ID to verify your name. If this card if for someone 15 and younger, a parent or guardian's ID must be submitted. You will be required to bring this Photo ID and a form of address verification to the library when you pick up your physical library card.
26. Address Verification
    If your Photo Identification does not contain your current address, please upload a scanned copy of any of the following address verification documents: Voter registration, Utility Bill, Lease, or Mail received within the last 30 days.
28. Parent or Guardian's Name
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field