Proxy Borrower Form

(This form should be submitted to the Library Privileges Desk - Doe Library, floor 1)

To: Library Privileges Desk

As a University of California Faculty/Academic Staff member at Berkeley, I request that the Library permit the person named below to withdraw books in my name for use in research.

Name of proxy: ______________________________ who is

(please check one)
/__/ employed by the University, privilege to expire June 30, current academic year
/__/ a registered student, privilege to expire at the end of the current semester
/__/ funded by grant or other research funds, privilege to expire end of research project, _______ (date).

I understand that I am responsible for all books borrowed under this privilege; that all recall notices will be sent to me; and that I am responsible for the return of all books or the payment of replacement bills for books that are lost or damaged.

Date:

Signature:

Department:

Print Name:

SearchSitemapContact webmasterUC Berkeley home

Copyright © 2007
The Regents of the University of California. All rights reserved.
Last updated 09/24/07. Server manager: contact