Proxy Authorization Form:Loyola University Chicago

Proxy Authorization Form

Law faculty may use this form to authorize students to check out library materials to their account.

Faculty will be contacted after receipt of the form to confirm the authorization.

Use the comments box for any additional needed information.

*Indicates required field

Sponsor Information
*Faculty Name
*Phone #
*Email
*Loyola ID #
Proxy Information
*Assistant Name
*Email
*Loyola ID #
*Begin Date
*End Date
Additional Comments
PLEASE READ: I authorize the aforementioned individual to charge library materials using my Loyola Library ID number. I understand that I am responsible for all materials charged to my ID during the authorization period. I will notify the library if I suspect unauthorized charges on my account.
*Signature