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 (if 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 http://www.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.