Proxy Borrowing Request Form

Your Name

Your Email

Your NetID

Your Contact Number

A phone number that you can be contacted at.

Name of Proxy

Proxy Expiration Date

Is the Proxy affiliated with Georgetown University?

Yes, the proxy is a student, staff or faculty member at Georgetown University.

No, the proxy is not affiliated with Georgetown University.

NetID of Proxy (required if affiliated with Georgetown University)

Email of Proxy (required if not affiliated with Georgetown University)

Agreement

I understand that by granting permission to the above designee, I am still responsible for all materials checked out in my name. I can view my patron record online at library.georgetown.edu/your-account to review borrowed materials, due dates, and requested items.

By checking this box, I am agreeing to the above.

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.