Borrowing Proxy Form | University of Pittsburgh Library System

Request Date

Month

Day

Year

Semesters *

Fall Term

Spring Term

Summer Term

(Please check one or all that apply)

Faculty Name *

Faculty ID# *

Teaching Assistant Name *

Teaching Assistant ID# *

Agreement *

By submitting this form, I am allowing my Teaching Assistant to borrow materials on my account as a proxy patron for the term/s indicated.

Please be aware that the faculty member is responsible for all materials, fines, and fees incurred on their library account.