Proxy Form

Use this form to allow a student or an SDSU employee to use your ID in checking materials out for you. Your ID must be
registered in the library system. If you have used your current ID card to check materials out from the library, it should be
ready to go. If not, please visit the circulation desk to register your ID. This form must be on file in the library and the
student must have your ID with them when they come to check materials out for you.

Type the information requested below and print this page.
Sign on the Signature of Faculty Member line.
Bring or mail the signed form to the library circulation department. (contact information listed below)

Date:

I authorize to use my I.D. in order to check out Library materials.

Permission granted until . (ending date required)

Faculty members name:

Department/Office Location:

Phone:

I realize that in signing this authorization form, I am responsible for all Library
materials borrowed by the person named above.

________________________________________________________________

Signature of Faculty Member

__________________________________________ (to be completed by library staff)

Circulation Supervisor Approval

Circulation Unit, South Dakota State University, Box 2115, Brookings SD 57007-1098, Phone (605) 688-5107, Fax (605) 688-6133.
Page last edited 4 January 2008 by db.

ID Card User Proxy Request Form

I realize that in signing this authorization form, I am responsible for all Library materials borrowed by the person named above.

I realize that in signing this authorization form, I am responsible for all Library
materials borrowed by the person named above.