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Proxy Card
Request Form

  


Fill out this form to allow a student to check out items on a proxy card. The professor is responsible for any items obtained with the proxy card.

1. Professor's name

2. Professor's Clemson ID number

3. Student's name

4. Student's Clemson ID number

5. Professor's email address

6. Semesters in which the proxy card will be used:

Fall
Spring
Summer Session 1
Summer Session 2

7. 8.

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Clemson, SC 29634-3001

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Updated August 22, 2007 | Copyright © 2003-2006 Clemson University. All rights reserved.
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