Designated Borrower Form

Faculty: Use this form to designate students who may borrow library materials on your behalf.  Please print this form, complete it and bring it to the Circulation Desk or mail to Karen Mehl, LITS.

Faculty Member: ___________________________________________

Department: _______________________________________________

Campus Phone: ____________________________________________

Email: ____________________________________________________

Name of designated proxy: ________________________________

Proxy's signature: __________________________________________

Date: __________________________

In designating a student to act as your library proxy you are authorizing that person to check out materials and request interlibrary loans on your behalf. You will be held responsible for the replacement costs, processing fees and any overdue fines that accrue for materials checked out in your name by your proxy. If your proxy leaves Mount Holyoke or is no longer working for you, please notify the library as soon as possible. Proxy privileges for student assistants expire at the end of the academic year.

Begin Date: __________________________

End Date: __________________________

Faculty member's signature: __________________________________

Date: ____________________________

If you have questions please contact Karen Mehl, x2061.