This form is used to ensure accountability for IT assets, such as computers, laptops, tablets or cell phones, that are loaned to agency employees, contractors, interns or other stakeholders requiring an ASDB asset.

Please do not use this form to request other items or services from IT.

If you require an ID Badge or Proxy Card please submit an ASDB Employee ID-Proxy Card Request

If you require an account to access network resources such as email (gmail) or Google Drive please submit ASDB Enterprise Account Agreement

If you require a video relay service (VRS) unit or software please submit an ASDB VRS Request

Date of Request*

MonthDayYear

Requester Position

ASDB StaffContractorInternVolunteer

Requester Name*

First NameLast Name

Requester Title*

Requester Department*

Requester Email*

Please only use an @asdb.az.gov email address

Requester Phone Number*

Please enter a valid phone number.

Requester Employee Identification Number (EIN)

Requester Supervisor*

Supervisor Email*

Please only use an @asdb.az.gov email address

Assigned Campus or Region*

Select your assigned Region or Campus

Date requester expects to receive equipment *

MonthDayYear

Device Requested - Check all that apply*

Agency Asset Tag

Please provide any further information IT needs to support your request.

Do you provide instruction or other services directly to students either in the classroom, virtual, your office or other work area?

YesNo

ASDB Asset Loan Responsibility Acknowledgement*

Asset Type

Manufacturer

Model Name or Number

Serial Number

Other Equipment Issued

IT Technician Notes

Status

Staff Asset Loan Request