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Equipment Utilization

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Equipment Utilization*

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Off-Site Use

In School Use

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Equipment Information

Item Description*

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Model Number

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Serial Number

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Asset Tag Number

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Reason for off-site equipment use:

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Address of proposed off-site location:

Street Address

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City

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Zip/Postal

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Date of Equipment Transfer*

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Expected Date of Equipment Return to Site*

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Borrower's Agreement

I agree to be responsible for the designated equipment item while it is in my possession and to return it by the above indicated date. I th item is lost, stolen, destroyed or otherwise rendered inoperative through my neglect, I agree to reimburse the Department of Education for the item at the replacement value. If the item is damaged, I Agree to pay for its repair. *

By typing your name in the space below, you agree to the above statement.

Answer required for "I agree to be responsible for the designated equipment item while it is in my possession and to return it by the above indicated date. I th item is lost, stolen, destroyed or otherwise rendered inoperative through my neglect, I agree to reimburse the Department of Education for the item at the replacement value. If the item is damaged, I Agree to pay for its repair. "

Confirmation Email

Confirmation Email *

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