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Research/Teaching Assistant Proxy Borrower Form

Research/Teaching Assistant Information

Name(*)
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14-digit library barcode(*)
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Faculty Information

Faculty Name(*)
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14-digit library barcode number: (*)
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Email Address(*)
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Phone Number(*)
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Authorized Borrowing Dates:

Proxy privileges are assigned for one semester, but may be renewed at the faculty member’s request.

Start Date(*)
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End Date(*)
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(*)

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