Proxy Server Access Request Form


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

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 asklib@mcw.edu 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)  *

Company/Clinic/Institution    *

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

Street address   *

City * Zip Code  *

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

Status:*
 Adjunct Faculty
 Emeritus Faculty
 Volunteer Clinical Faculty
 Children's Hospital employee
 Froedtert/Dynacare employee
 Joint Graduate Degree program

Department affiliation:*

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 asklib@mcw.edu or contact us at (414) 955-8302 if your form is not successfully submitted.

 

Medical College of Wisconsin
8701 Watertown Plank Road
Milwaukee, WI 53226
(414) 955-8296
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Page Updated 07/06/2015
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