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Faculty Account Proxy
Please fill out this form and bring the completed form to the Circulation Desk at Ikeda Library. By
signing this form, you are authorizing Ikeda Library to check out materials on your account to this
student. You are responsible for the replacement fees if any library items are lost, including fees for
materials borrowed by your student proxy. Proxy privileges must be renewed each semester, and it
is your responsibility to notify the library of the last day the proxy is authorized to borrow materials
on your account if this student will not be your proxy for the whole semester.
Date Semester/Block
Professor's name
Student/Proxy's name
Note
____________________________________ ___________________________________
Signature of the Professor Signature of the Student/Proxy
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Completed 23 September 2021

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