Faculty Authorization Form - Interlibrary Loan/Document Delivery

Faculty Authorization Form
For Interlibrary Loan/Document Delivery

Faculty Member's Name:
Faculty Member's Department:
Faculty Member's Address:
Faculty Member's Phone:
Faculty Member's Email:
Circulation issued Proxy check-out card number:
Proxy's Name:
Proxy's Email:
Pick-up Library:
Home Library:
Proxy Card Information: If you later wish to have the account cancelled, please contact interlibrary loan staff who can cancel the account and prohibit any further checkouts or requests placed. All notices will be sent to the faculty member and to the proxy. A list of items checked out or requested via the Proxy card can be viewed by logging in to the Interlibrary Loan/Document Delivery system. To access the proxy account use the three sets of three numbers from the pink barcode number on the proxy card as the Hawk ID. The password will be emailed to you shortly after submission of this form. If you do not have a Circulation-issued proxy card, please fill out the faculty authorization form and turn into library staff at any library. By submitting this form, I authorize this person to check out Interlibrary Loan materials in my name. These items are for my use only and I accept full responsibility for them.