University of Connecticut Health Center Library
Proxy Registration Form
for
UConn Graduate/Undergraduate Students


Please provide the following information in order to apply for UCHC library borrowing and electronic library access privileges as a UConn graduate/undergraduate student. Only undergraduate students in the School of Nursing, Pharmacy, Allied Health and Nutrition may apply. If you prefer, you may submit your information via e-mail.


Patron Name: *

E-mail Address (UConn Email Preferred): *

Campus Information

Status: * Class of: *

UConn School or Department*

Contact Person for School or Department: *

Campus Residence Information

Street Address: *

City: * State: * ZIP code: *

Campus Phone No. : *

Permanent Address

Street Address: *

City: * State: * ZIP code: *

* I accept the UConn Health Center Library Terms of Use

The fields with "*" are required fields.

The information required in this application is necessary in order to comply with electronic database licensing requirements and to limit library borrowing privileges to those who are part of the UConn community.

Send questions to Circulation Department at circ@uchc.edu