Miller Nichols Library Proxy Extend Form

Please submit completed form to Miller Nichols Library Access Services. You may fill in the information online and print it or print the form and fill it in by hand. As a signature is required, you must submit a print copy of the form. If you have any questions call Miller Nichols Library Access Services at (816) 235-1526.
Please extend proxy borrowing privileges in my name
Faculty Name:
UMKC I.D. No.
Department:
Office Address:
Office Phone #:
Email (if used):
for the following proxy individual(s): Proxies must be currently associated with UMKC. If any of these proxies are renewals, please check the boxes below for those proxies. These proxies will need to bring their Proxy Cards to MNL Access Services to get renewal stamps.
Proxy Name:
UMKC I.D. No.
Renew this proxy.

Proxy Name:
UMKC I.D. No.
Renew this proxy.

Proxy Name:
UMKC I.D. No.
Renew this proxy.

Proxy Name:
UMKC I.D. No.
Renew this proxy.

I understand that Access Services will create a record under my name in conjunction with each proxy that will allow the proxy to request items via Interlibrary Loan and check out Miller Nichols Library and interlibrary loans items in my name. I understand that each proxy must show his or her own photo identification and proxy card when checking out items or picking up interlibrary loan materials. Granting of privileges is subject to the approval of the Access Services Department. Privileges are for the current semester only and may be extended by completion of a new request. I understand that all proxy mail will be sent to me and I am financially responsible for materials borrowed in my name. Spring semester ends May 9, 2008. Signature: ____________________________Date: __________________________ (Sign printed copy and submit to MNL Access Services OR fax to: Attn. Mary Anderson at (816) 235-5531.)

Miller Nichols Library
5100 Rockhill Road Kansas City, Missouri 64110	Phone: (816) 235-1534 Fax: (816) 333-5584 MNL Email Reference (http://library.umkc.edu/forms/mnlref.htm)

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Page updated February 28, 2008

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Miller Nichols Library Proxy Extend Form

Please extend proxy borrowing privileges in my name

for the following proxy individual(s):