Proxy Request Form

Proxy Request

You may grant permission for another person to check out materials from Hamersly Library on your account. This includes picking up materials that arrive for you through Summit and Interlibrary Loan. If you have questions about this service, please contact Lori Pagel at pagell@wou.edu or 503-838-8881

Your Name(Required)

First Last

Your vNumber(Required)

Email address of person you are authorizing to check items out(Required)

vNumber of the person you are authorizing (if applicable)

If the person is affiliated with WOU, please provide their vNumber

Name of the person you are authorizing(Required)

First Last

When should the authorization should expire?

Please enter the date after which this person will no longer be authorized to check items out on your behalf. You may submit another form if this date changes.

The proxy presents their own WOU ID at the time of checkout--not yours.
You receive an email receipt anytime loans are made to your account.
By authorizing a proxy, you accept all responsibility for items checked out to your library account, including any applicable charges.
All proxy authorizations will expire no later than June 30 of the current fiscal/academic year. If you need to rescind an authorization earlier than you expected, please contact us.
If your proxy is not WOU student, faculty, or staff, they must obtain a Hamersly Library Community Borrowers card. Applications are at the Checkout Desk.
The authorization is limited to checking out physical materials at Hamersly Library.

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Western Oregon University’s Land Acknowledgement
Western Oregon University in Monmouth, OR is located within the traditional homelands of the Luckiamute Band of Kalapuya. Following the Willamette Valley Treaty of 1855 (Kalapuya etc. Treaty), Kalapuya people were forcibly removed to reservations in Western Oregon. Today, living descendants of these people are a part of the Confederated Tribes of Grand Ronde Community of Oregon and the Confederated Tribes of the Siletz Indians.

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