Proxy Form

Faculty please note: 

• By designating another person to act as your proxy, you are authorizing that person to check out materials, make copies of microforms, or request interlibrary loans on your behalf.
• You become responsible for the replacement costs, service charges, and any overdue fines that accrue for materials checked out in your name by your proxy.
• If your proxy leaves UPS or is no longer working for you, please notify the library as soon as possible.
• Proxy privileges for student assistants expire after one academic year. They may, however, be renewed at the request of faculty.
• Any questions concerning this program should be directed to Cassandra Palmore, 253.879.3612.

Please print.

Faculty Name: _________________________________________________

Department:   _________________________________________________

Name of Designated Proxy: ____________________________________

Proxy Signature and Date:   ____________________________________

In making this request I acknowledge that I am financially responsible for all library material charged to my name by the above named representative.

Faculty Signature and Date: ____________________________________