EKU Libraries

Proxy Borrower Application

Note: As an EKU Faculty member, you may authorize assistants to charge out Library materials on your behalf. These assistants must be employed by the University or be registered students. Under this arrangement, you agree to be responsible for any materials borrowed on your behalf, including the return of all materials or the payment of replacement charges of items that are lost or damaged. Proxy authorization may be granted for up to one academic year, and may be renewed as necessary.

Designated Proxy Information
First Name: *
Last Name: *
EKU ID Number: *
This permission is to expire: *


Faculty Member Information
First Name: *
Last Name: *
EKU ID Number: *
Email:
Department:


Agreement / Authorization:
I understand that by granting permission, I am assuming responsibility for all materials checked out in my name. In order to have your request activated, print out the completed and previewed form and bring the signed form to the Circulation Desk. If you have any questions please contact Joseph Berend at kenneth.berend@eku.edu.

Date:

Signature: