Proxy Authorization Form

Faculty members and Professional and Scientific staff may authorize others to check out material in their name. The faculty member or Professional and Scientific staff person must fill out the authorization form below. The patron who is checking out material must present their own UNI ID, not the faculty or staff member's ID.

Faculty/P&S Authorization/Proxy Form

Contact Info.

Select All That Apply

Fall

Spring

May Term

Summer

Full Name

Email Address

Department

Department Zip

Campus Phone

Authorized Users

Check Out Material In My Name

Request Photocopy In My Name