Proxy Access Request Form

Volunteer clinical faculty, adjunct faculty, emeritus faculty, students in joint degree programs


MCW Faculty, staff, students and residents should use their MCWCORP/MCW email username and password to log onto the proxy server.

CHW, Froedtert Health and Wisconsin Diagnostic Laboratories Staff should fill out an alternate form.

Please review the form before submitting. MCW Libraries will verify your status and contact you within five to seven business days with your proxy login information.

Questions? Contact the MCW Library at (414) 955-8302 or asklib@mcw.edu between 8 a.m. and 4:30 p.m.

*  Required Field

Name:   *

Email:  *

Phone (w/Area Code):  *

Company/Clinic/Institution:  *

Please provide a home or business address, whichever is the best one to reach you:

Street Address:  *

City, State, Zip:  *

If the zip code above is a business, please provide your home zip code:

Status:*

 
 

If applicable, enter your program end date or appointment expiration date: 

Department/Program Name:

Department/Program Contact's Name: 

Department/Program Contact's Phone: 


Notes: please provide any additional information you feel is necessary to clarify your status:

After submitting the form, you will see a confirmation message on your screen and you will be sent a confirming email.  If you do not see either, your request form was not successfully submitted.  

 

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8701 Watertown Plank Road
Milwaukee, WI 53226
(414) 955-8296
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Page Updated 03/11/2016
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