Information Center Proxy Borrower Form

As SU faculty members or SU members with a disability you may authorize a proxy borrower to check out IC materials on your behalf. Under this arrangement, you agree to be responsible for any materials borrowed on your behalf, including the return of all materials or the payment of replacement charges of items that are lost or damaged. SU faculty members or SU members with a disability must have an IC account in good standing in order to request or renew a proxy borrower. Any overdue recalls, lost books, etc. must be resolved before a proxy relationship can be created or renewed. Expiration date of the proxy borrower card may be renewed as necessary, by completing the form again.

Who can be a proxy borrower?

  • SU Research Assistants or Students (active)
  • SU Staff (active)
  • Person affiliated with user with a disability

The materials will be checked out to your IC account. All notices will be sent to you via email.

This privilege is intended to help members with a disability and faculty members in their research work for the University, not for any other purpose. You can just check out items with this privilege.

In order to create a card, please fill in the form and send your proxy borrower’s photo by email. To borrow material, the proxy borrower will present this card.

Authorizing Member (SU Faculty members and SU members with a disability)

Authorized Borrower's

Authorized Borrowing Dates;
Proxy privileges may be assigned for up to one year at a Time.



I understand that by granting permission, I am assuming responsibility for all materials checked out in my name. If you have any questions please contact at

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