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Tomlinson Library Faculty Proxy Request
CMU faculty may use this form to designate a CMU-affiliated proxy, such as an administrator, teaching assistant, student work-study, or intern, for purposes of checking out library materials or picking up Interlibrary Loan items. The designated proxy must bring their own photo ID and the faculty MAVcard to the Checkout & Reserves Desk to check out materials.

For help completing this form, contact the Checkout & Reserves desk at 970.248.1244.

View this form at http://bit.ly/mavproxy.

Faculty Name
Your answer
Faculty 700#
Your answer
Faculty Preferred Email Address
Your answer
Faculty Preferred Phone Number
Your answer
Proxy Name
Your answer
Proxy Email
Your answer
Begin date of proxy authorization
MM
/
DD
/
YYYY
End date of proxy authorization
MM
/
DD
/
YYYY
I authorize my proxy to do the following:
Check all options that apply.
Required
Acknowledgement of Responsibility
Required
Acknowledgement of MAVcard use
Required
Anything else?
Feel free to let us know any other information that helps us process your request.
Your answer
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