Research assistant proxy card form

Regular faculty and staff can apply for a research assistant proxy card that authorizes another individual to check out materials, place holds, request interlibrary loan items, and access electronic resources on their behalf. To obtain a card, complete the application form below. By submitting this form, you confirm that:

  • you request this card only for the purposes of support for your research (the card may be revoked if it is used for other purposes)
  • you accept responsibility for any materials charged to this account, including payment of fines and fees
  • the card will only to be used by the person whose name appears on it.

The card, along with a copy of this application, will be mailed to you. Please have your authorized user sign the card as soon as possible.

Information and privacy: questions regarding the collection of information on this form can be directed to the form administrator.

Faculty/staff member's information

Authorized user's information

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