Proxy Borrower Form

Fields marked with an * are required

A proxy borrower can be designated to borrower material on your Library account.  Proxy borrowers must be employed by the University or be registered students with Library accounts in good standing.  The primary borrower is responsible for material borrowed and any fines incurred.
 
 
Complete this form with information for both the proxy and primary borrowers.  Both borrowers will be contacted within 3 business days.
 
 
Questions about proxy borrowing should be addressed to Access Services at 631-632-7115.
 



Enter the date the proxy borrowing privileges will expire.

I understand that I am assuming responsibility for all materials checked out in my name.