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Application for a Library Proxy Card


(For UMass faculty and staff. Students registered with Disability Services also eligible.)

New    Renewal

*Last Name: First Name:
*Email:
*Campus Address:
*Campus Phone:
*Library Bar Code #: (15 digit # on staff ID)

*Proxy Name: From: To:  (Month/Year)

All current UMass Amherst faculty and staff are eligible for a Library proxy card. Students who are currently registered with Disability Services will need to provide a letter of authorization from Disability Services requesting Library Proxy card eligibility."

Personal Agreement: I agree that I will be responsible for all materials charged out on the proxy card and I will respond to all correspondence concerning charges on this card (e.g. overdue notices).

* I have read and agree to the Personal Agreement.

Proxy must present their photo ID when picking up the Proxy Card

*Please select a pick-up location:
    

Lost or stolen cards should be reported immediately.

* Required Fields