Proxy Borrower Authorization Form
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1PROXY BORROWER AUTHORIZATION FORM
TODAY’S DATE: ____________________
SESSION: _____ FALL _____ SPRING _____ SUMMER
DEPARTMENT: ________________________________________________________________
FACULTY NAME (Please Print): _____________________________________ _____________
TELEPHONE:
_________________________________________________________________
EMAIL: ________________________________________________________________________
I accept all responsibility for all materials checked out in my name by the proxy borrower specified
below.
Faculty Signature: ________________________________________________________________
Authorized Proxy Borrowers:
NAME: ________________________________________________ OASIS #:_________________
NAME: ________________________________________________ OASIS #:_________________
NAME: ________________________________________________ OASIS #:_________________
PROXY BORROWER AUTHORIZATION FORM
TODAY’S DATE: ____________________
SESSION: _____ FALL _____ SPRING _____ SUMMER
DEPARTMENT: ________________________________________________________________
FACULTY NAME (Please Print): _____________________________________ _____________
EMAIL: ________________________________________________________________________
TELEPHONE:
_________________________________________________________________
I accept all responsibility for all materials checked out in my name by my proxy borrowers
Faculty Signature:________________________________________________________________
Authorized Proxy Borrowers:
NAME: ________________________________________________ OASIS #: __________________
NAME: ________________________________________________ OASIS #: __________________
NAME: ________________________________________________ OASIS #: __________________
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