Western Libraries Proxy Borrower Authorization Form

Include your Department and Mail Stop

Responsibility Statement:

I authorize the Proxy Borrower above to borrow books under my name and in my absence from Western Libraries. I accept full responsibility for any books borrowed by my proxy during the authorized period of affiliation. I understand that the Proxy Borrower may be required to show their own piece of photo identification, and will need to provide my W# in order to check out materials on my behalf.