Circulation Proxy Borrower Authorization

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Library Services - Circulation
Proxy Borrower Authorization
I am authorizing the named individual below to borrow library materials and perform
other library transactions on my behalf using a proxy library privilege linked to my Library
account. I understand that proxy library privileges are only extended to current staff and
students of FGCU who are sponsored by FGCU faculty.
I assume responsibility for all transactions charged to this proxy account including
responsibility for any fines and bills incurred. I understand that the proxy borrowing card
will be issued to a specific individual and is not transferable to another borrower.
Signature:
_________________________________ Date:_____________
Sponsor Information:
Name: _________________________________
FGCU ID: _______________________________
Department: ______________________________
FGCU Address:____________________________
Email:____________________________________
Phone:___________________________________
Expiration date for proxy privilege: ______________________________
All proxy privileges expire at the end of the academic year unless an earlier date
is indicated here. A new authorization form must be submitted to retain proxy
privileges for this person each year their services are required.
Proxy Information:
Name: ________________________________ FGCU ID: __________________
LIBRARY USE ONLY:
Proxy’s barcode verification number (UIN): ______________________________
Proxy’s barcode (14-digit library ID #):__________________________________
Sponsor’s system ID: _______________________________________________
Revised 3/24/09

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