Please complete all information. Your Proxy will NOT be permitted to borrow or request items if this form is incomplete. Faculty Name * Faculty G# * Department * Mason Email * I authorize the designated proxy to borrow library materials on my behalf THROUGH JUNE 30 of the current academic year. If SHORTER TIME PERIOD is required, please state Expiration Date: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Proxy Name * Proxy G# * My proxy has my permission (check the appropriate box to APPROVE) : To borrow Books and/or Media from Mason Libraries To pick up Books and/or Media requested through Washington Research Library Consortium (WRLC) Loan Service INTERCAMPUS LENDING / INTERLIBRARY LOAN AUTHORIZATION The following services require the requesting Mason faculty member to have an active ILLiad account. Please visit https://gmu.illiad.oclc.org/illiad/VGM/logon.html to create/update your ILLiad account. My proxy has my permission (check the appropriate box to APPROVE) : To pick up Books and/or Media requested through Document Delivery Service (also called Intercampus Lending) To pick up Books and/or Media requested through Interlibrary Loan (ILL) Service ACKNOWLEDGEMENT I understand I am responsible for all materials * I understand I am responsible for all materials checked out in my name and any associated fines and/or fees for those items. I understand my library privileges may be suspended * I understand my library privileges may be suspended for failure to comply with established George Mason University Libraries’ policies. Leave this field blank