Volunteer clinical faculty, adjunct faculty and emeritus faculty should submit this form even if they have MCW e-mail addresses.
Please review the form before submitting.
MCW Libraries will verify your status with the Office of Faculty Affairs and the appropriate department, and contact you within five to seven business days with your proxy login information.
Questions? Contact the MCW Library at (414) 955-8302 or email@example.com between 8 a.m. and 5 p.m. or Circulation at (414) 955-8300 on evenings and weekends.
* = Required Field
First Name *
Last Name *
E-mail Address *
Phone Number (w/Area Code) *
Please provide a home or business address, whichever is the best one to reach you:
Street address *
City * Choose a StateOutside US / CanadaAlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasArmed Forces AmericasArmed Forces EuropeArmed Forces PacificBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNorthern Mariana IsNorthwest TerritoriesNova ScotiaOhioOklahomaOntarioOregonPalauPennsylvaniaPrince Edward IslandProvince du QuebecPuerto RicoRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYukon Territory* Zip Code *
If the zip code above is a business, please provide your home zip code:
Volunteer Clinical Faculty
Children's Hospital employee
Joint Graduate Degree program
Choose a departmentAcademic AffairsAnesthesiologyBiochemistryBiophysicsBiotechnology and Bioengineering CenterBone Marrow Transplant (CIBMTR)Cancer CenterCardiovascular CenterCell Biology, Neurobiology and AnatomyCenter for Bioethics and Medical HumanitiesCenter for Public and Community HealthClinical AffairsClinical InformaticsClinical and Translational Science Institute (CTSI)DeanDermatologyEmergency MedicineEndocrinologyFamily MedicineFinance and AdministrationFunctional Imaging Research CenterGastroenterologyGeneral Clinical Research Center (now CTSI)GeriatricsGovernment & Community RelationsGraduate Medical EducationGraduate SchoolHuman and Molecular Genetics CenterInfectious DiseasesInformation ServicesInstitutional AdvancementMedicineMicrobiology and Molecular GeneticsNeoplastic DiseasesNephrologyNeurologyNeurosurgeryObstetrics and GynecologyOphthalmologyOrthopaedic SurgeryOtolaryngologyPathologyPediatricsPharmacology and ToxicologyPhysical Medicine and RehabilitationPhysiologyPlastic SurgeryPopulation HealthPractice ManagementPresidentPrimary Care InitiativePsychiatryPublic AffairsPulmonaryRadiation OncologyRadiologyRheumatologySurgeryUrologic SurgeryUrology
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 e-mail. If you do not see either, your request form was not successfully submitted. Please e-mail firstname.lastname@example.org or contact us at (414) 955-8302 if your form is not successfully submitted.
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