Application for Proxy Borrower for Students with a Disability
ABN 63 942 912 684
If you have a disability that prevents you from borrowing in person or from attending the library regularly, the Library offers a service to assist you. If you would like to nominate another person to borrow on your behalf, please:
  • fill in the details below;
  • print the form;
  • sign the form;
  • have the nominated borrower sign the form; and
  • hand in at any Branch Library, or send to: Circulation, Information Access Service, The University of Queensland Library, Duhig Building Level 1, St Lucia Campus, Qld 4072.

A library card with your name and the name of the person authorised to borrow for you will be sent to you. The signature panel on the card must be signed by the nominated borrower.

You will be responsible for any material borrowed on your behalf under such authorisation, including payment of replacement costs if necessary.

Fields marked * are compulsory.

Nominated Borrower
Name * (BLOCK letters)

Home address *
Email address *
Phone No. * (At least one)  
   Home
   Work
   Mobile
Duration of Authorisation * From:     To:  
Signature of nominated borrower: ........................................................................
Authorising student
   I understand that I am responsible for the return of library materials borrowed on my behalf and that I may be charged for the replacement of material not returned.

Name *
(BLOCK letters)
Student number *
Date *
Signature of authorising student:   ........................................................................
Library use only
Date received 
Expiry date 
Barcode24067
Patron type 
Stat class