PATRON AUTHORIZATION REQUEST FORM by ert634

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									                                                                                         University Libraries




                   PATRON AUTHORIZATION REQUEST FORM

Patron Authorization is a privilege offered to allow another individual to utilize The Ohio State
University Libraries services in a patron’s name. Once this form has been completed and submitted to
any OSU Libraries circulation desk, the authorized individual will have permission to check out
materials at any OSU Library. Authorized individuals will also be able to pick up interlibrary loan
requests at the Thompson Library; the Food, Agricultural and Environmental Sciences Library; and the
Biological Sciences/Pharmacy Library circulation desks for the patron. The Libraries recommends that
no more than four individuals be authorized at any time, and that individuals be authorized on a quarterly
basis. The Libraries also encourages patrons who are authorizing individuals to utilize library services to
view their My Library Account record weekly. If you need to make changes to individuals authorized
on your library account, please contact at staff member at any OSU Library circulation desk.

Please note: Eligibility for this service applies to graduate or undergraduate student assistants of OSU
faculty; spouse or domestic partners of OSU faculty and staff; and individuals with permanent or
temporary disabilities.

                 ALL FIELDS MUST BE COMPLETED TO PROCESS THIS FORM


Name (please type/print):

University ID# or Barcode#:

Campus Address:

Phone:



I authorize the following person to utilize the above mentioned library services in my name:

Name of Authorized Individual (please type/print):

University ID# or Barcode#:

Address:

Phone:

EXPIRATION DATE (mm/dd/yyyy):
     Note: The Expiration date may be no longer than one year from the date of the application

Signature of Patron:                                                        Date:

Signature of Authorized Individual:                                         Date:
                                           Reset Form          Print Form           Submit by Email

								
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