Proxy Borrowing Request Form

A phone number that you can be contacted at.
Is the Proxy affiliated with Georgetown University?

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 to review borrowed materials, due dates, and requested items.

By checking this box, I am agreeing to the above.
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.