Equipment Loan Request Form | Arts & Sciences Computing

Affiliation *

Your contact information:

First and Last Name *

Email Address *

Phone Number *

Department *

Are you making this request on behalf of someone else? If so, please identify that person; students, please identify the instructors for your course. *

First and Last Name *

Email Address *

Phone Number *

Department *

Course Name/Number *

Is the request related to an SAS class or special event? *

Purpose of Loan *

What equipment do you need? *

Will you pick up the equipment at MMS or would you like it delivered? *

Where? (Building, Room #) *

When do you need the equipment?

Delivery Date *

Month

Day

Year

Delivery Time *

Hour

:

Minute

When will the equipment be returned?

Return Date *

enter the day you plan to return the equipment

Month

Day

Year

Return Time *

enter the time you plan to return the equipment

Hour

:

Minute

am

pm

Loans require your department's approval. Your business administrator will be asked to provide MMS with a university budget code and will agree to take on financial responsibility for loss or damage of any equipment provided by Multi-Media Services (MMS). Please provide us with your BA's name and email address so we can request confirmation.

Business Administrator's Name

Business Administrator's Email

Other instructions or information about this loan request

When will you pick up the equipment?

Pickup Date *

Month

Day

Year

Pickup Time *

Hour

:

Minute

am

pm

Student Return Date *

Month

Day

Year

Student Return Time *

Hour

:

Minute

am

pm

What equipment do you need? *

Course/Event Description *