This form may be used by faculty and academic staff to register a student or staff member to check library materials out in your name.

This is not a submittable online form—it must be printed on UW-Stout or departmental letterhead to verify its authenticity and include your signature for authorization.


  • Download the Proxy Patron Authorization Form (in PDF).
  • Print the form onto UW-Stout or departmental letterhead.
  • Fill out the form with all necessary information
  • Be sure to sign the form!
  • Return the completed form to the Library Circulation Desk via campus mail (Robert S. Swanson Learning Center Room 123), via FAX 715/232-2618 or in person.  This form cannot be submitted via email.

The names on this form can be changed at anytime, as can the expiration dates.  To ADD proxies, simply send a new signed authorization.  To REMOVE an authorization, call the Circulation Desk at 715/232-1215 or email.


Check your patron record (click on the "My Acccount" Tab) in Search@UW regularly for misuse.

If you need assistance, please contact the circulation desk staff.

Last Revised: 06/08/2011    Last Updated: 04/07/2016
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