Proxy Borrower Request Form

Faculty/staff first name

Faculty/staff last name

Faculty/staff Tufts email address

Proxy first name

Proxy last name

Proxy Tufts email address

End Date

The default end date for proxy privileges is the upcoming August 1st unless indicated otherwise.

I understand I am responsible for all materials checked out in my name and any associated fines and/or fees for those items.

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