Proxy Authorization Request - Georgia State University Library

Faculty can use this form to submit a proxy authorization request to allow another user to checkout Georgia State University library materials and pick up interlibrary loan or GIL Express books on their behalf. Requests for materials must be made by faculty themselves. Under this arrangement, the instructor agrees to be responsible for responding to notices, returning/renewing materials on time, and paying any fees for books that are lost or damaged.

Faculty Member’s Name*
Department*
Campus*
Faculty PantherCard Number*
Faculty Email*
Proxy Name*
Proxy PantherCard Number*
Proxy Email*
Signature*
- I authorize the above designee to check out or pick up library materials on my behalf. I understand that once my proxy has checked items out for me, the materials are my responsibility and appear on my library account exactly as if I had checked them out myself. I assume financial responsibility for lost, stolen, or damaged materials checked out in my name.
Authorization Expiration Date
CAPTCHA
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