Volunteer clinical faculty, adjunct faculty and emeritus faculty should submit this form even if they have MCW email 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 MCW Library Systems at 414-955-4290 or firstname.lastname@example.org between 8 am and 5 pm, or Circulation at 414-955-8300 on evenings and weekends.
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First Name *
Last Name *
Email 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:
Status:* Adjunct Faculty Emeritus Faculty Volunteer Clinical Faculty Children's Hospital employee Froedtert/Dynacare 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):
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