Faculty Resources - Library Authorization Request

For your convenience, we allow you to authorize others, whom you specify, to check out or renew library materials on your behalf.

Use this form to provide us with the information we need in order to provide this service safely.

Please be aware of the following:

Although a person you have authorized checks out materials for you, you retain responsibility for those items. This includes responsibility for returning the items by their due dates and returning them in the condition they were in when they were checked out.
If you have any questions or concerns, please contact the MJC Library Circulation Desk at 209-575-6228.

INFORMATION ABOUT YOU
Instructor's Name:
Instructor's Employee Number (if known):
Campus Extension:
Home Phone (If no Campus Extension):
Email:

I hereby authorize the following person(s) to check out and/or renew library materials on my behalf.

AUTHORIZATION INFORMATION Unless otherwise noted (below) authorizations will expire at the end of the academic year.
Authorized User 1: (First Name & Last Name)	Authorization will expire on: (MM/DD/YYYY)
Authorized User 2: (First Name & Last Name)	Authorization will expire on: (MM/DD/YYYY)
Authorized User 3: (First Name & Last Name)	Authorization will expire on: (MM/DD/YYYY)
Anything else you want us to know about this? Please comment below: