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Equipment Check Out Request Form
Equipment Check Out Request Form
This form will allow students to request information about available AT and equipment.
Name
(Required)
Trojan ID Number
(Required)
Email Address
(Required)
Phone Number
(Required)
Desired Equipment
(Required)
Select One
Amplified Stethoscope
Assistive Listening Device (ALD)
CCTV for Classroom Installation
Intel Reader
JAWS Screen Reader On Campus Installation
MAGIC Screen Magnifier On Campus Installation
Portable CCTV
Other
Other equipment
Please indicate what equipment you're requesting. If it's not on the list it may not be available.
Please list building name, room number, station number, or any other information that will help us in properly installing the AT for you.
Agreement
(Required)
I understand and agree to the following: I, the student, am responsible for returning equipment on or before the due date, in the same condition in which it was borrowed. I will be held liable for any damage or loss of equipment and will be charged by the University for repairs and/or replacement, if damage resulted from anything other than normal usage. In the event that equipment is not returned in satisfactory condition and in the time frame specified on the form, my records may be flagged to prevent future registration, obtaining transcripts or other records.
Captcha
Comments
This field is for validation purposes and should be left unchanged.
