Proxy Card Application Form

The Libraries will issue no more than three Proxy cards per faculty member (one form is required for each card). Proxy cards will have an expiration date of not more than three years from the date of issue.

Liability Notice: The faculty member assumes full responsibility for all materials checked out on Proxy cards issued in their name. UTK Libraries will not be responsible for confirming the identity of any Proxy Card Holder. Lost or stolen cards should be reported to the Hodges Library Circulation as soon as possible.

Submission Notice: By submitting this form you give consent for an Electronic Signature to be placed on your official Proxy Card Application and state the following:

“I would like the University Libraries to issue in my name a Proxy card which, when used, will result in library materials being charged to me. I assume full responsibility for determining who may and who may not use this Proxy card. I understand that materials borrowed on this Proxy are governed by loan policies for faculty, and that I will receive any recall or overdue notice(s) that may be required. I also assume full responsibility for all losses, damage, or fines incurred by the person borrowing under this authorization.”


All fields are required.
  • Please pick a date no more than 3 years from the date of this application. Your proxy card will be mailed via campus mail to you within one (1) business day.