Fillable Proxy Patron Application Application for Proxy Patron

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Proxy Patron Application Application for Proxy Patron

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The Proxy Patron Application Application for Proxy Patron form is 1 page long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for Eastern Michigan University

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Application for Proxy Patron
Faculty and staff at Eastern Michigan University may have as many proxy patrons as
needed for another person to borrow library materials on their behalf. Please use a separate
form for each proxy.
FACULTY AND STAFF IN WHOSE NAME THESE PROXY PATRONS RECORDS
ARE CREATED ARE RESPONSIBLE FOR ANY ITEMS CHARGED OUT IN
THEIR NAME.
(*) denotes a required field
Requester Information
Faculty /Staff Name (*) Last Name, First Name:
Department (*):
E-mail(*):
Phone(*):
Name of Proxy (Last Name, First Name) (*):
Date When Proxy privileges end (mm/dd/yy):
I understand that I am responsible for all materials charged out to me by my proxy.
Signature Date
12/11/03
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Proxy Patron Application Application for Proxy Patron

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Completed 21 February 2020

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