lib-desk@listserv.uic.edu $email Faculty Authorization Form Web Form: $fm_referer Date: $fm_date Name: $name Dept: $department m/c: $mail_code E-mail: $email Phone: $phone Period: $period ID No.: $id_number Rank: $rank I authorize the following person(s) to charge out, pick-up, or request library items in my name: Person 1: $person_1 Period: $person_1_period Person 2: $person_2 Period: $person_2_period Person 3: $person_3 Period: $person_3_period $email lib-desk@listserv.uic.edu PATRON RECEIPT: Faculty Authorization Form For your records, the following Faculty Authorization Request Form was submitted to the Library on $fm_date: Web Form: $fm_referer Date: $fm_date Name: $name Dept: $department m/c: $mail_code E-mail: $email Phone: $phone Period: $period ID No.: $id_number Rank: $rank I authorize the following person(s) to charge out, pick-up, or request library items in my name: Person 1: $person_1 Period: $person_1_period Person 2: $person_2 Period: $person_2_period Person 3: $person_3 Period: $person_3_period Thanks

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