Proxy Borrower Form (Faculty Use Only)

Form to be used by faculty to designate individuals to check-out materials at the University Libraries.
Name *
Email *
1. Faculty Name *
2. Date *
3. Proxy Borrower's Name *
4. Proxy Borrower's U Number *
5. I hereby authorize the Proxy Borrower listed above to act as my Proxy Borrower at the University Libraries during the semester listed above. I am aware that the Proxy Borrower will charge Library material(s) in my name and that the identity of the Proxy will not be recorded in the record(s) of the loan transactions. The material will be charged to me as though I had completed the transaction(s) myself. Once charged to me, by the Proxy Borrower, the material becomes my responsibility and I am aware that the material is to be returned or renewed before it becomes overdue. I am responsible for paying all fines and fees that may result from the loan transactions. I understand that I may have up to 2 individuals simultaneously designated as a proxy for me. I am responsible for submitting one of these forms for each person authorized by me as a Proxy Borrower. I am responsible as detailed above for all material charged at any time using a proxy card bearing my name and identification number. *
Agree