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Proxy Patron Authorization: Proxy Patron Authorization

Proxy Patron Authorization

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 Library and Learning Center Room 123) or in person.  This form cannot be submitted via email.

The names on this form can be changed at any time, 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 Account" Tab) in Search@UW regularly for misuse.

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