Field Info: Proxy Request Form
Utility Software Services - Departmental Proxy Request Form
Please note: only a Dean, Director, or Department Head may authorize a departmental proxy.
This form should be completed by the "authorizing" individual for the proxy.
Below, please list the proxy individual with one department number per line.
(An individual will be listed more than once if he/she supports multiple
departments.) You may list up to ten individuals to act as proxy for one department number.
** Please be sure to specify the desired action. **
Please enter any additional comments here.
Purdue University, West Lafayette, IN 47907 USA, (765) 494-4600 © 2014 Purdue
University. An equal access, equal opportunity
If you have trouble accessing this page because of a disability, please contact ITaP at firstname.lastname@example.org.
Inquiries or comments: email@example.com