Faculty Office Delivery Proxy Permissions Form | University of Pittsburgh Library System

Please use this form to designate between 1-5 staff and/or student assistants in your department to accept Faculty Office Delivery services in your absence.

Academic Year *

Faculty Name *

Faculty 2P *

Faculty Office Location *

Faculty Email *

1. Proxy Information

Name *

2P Number *

Office Location *

2. Proxy Information

Name

2P Number

Office Location

3. Proxy Information

Name

2P Number

Office Location

4. Proxy Information

Name

2P Number

Office Location

5. Proxy Information

Name

2P Number

Office Location

Authorization Agreement *

By submitting this form, I am authorizing the above noted staff and/or student assistant proxies to accept Faculty Office Delivery services in my absence.

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

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