Equipment Check-Out Agreement

Equipment Check-Out Agreement

2025-2026
To be completed jointly by TRiO SSS Staff & Student
Name

First NameLast Name
Student ID Number (A#)
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Personal Email
Please enter a valid email address.
PCC Email
Please enter ONLY your PCC email address
{email} is not a valid PCC email address
Equipment Type

Other
Internal Laptop ID Number
PCC Laptop Tag Number
Laptop Accessories

Other
Internal Calculator ID Number
Date

MonthDayYear
Date checked out
Choose up to one option:
Period of Rental
Days of Rental
Due Date

MonthDayYear
The TRiO SSS program provides students free equipment rentals. You will be held accountable for the care and return of the equipment.

Please review the following statements carefully:
- TRiO SSS equipment is for academic purposes only. Violations and/or illegal use of PCC equipment usage policies include: pornography, unauthorized access to data files, releasing a virus or other malicious software, and abuse of copyright laws.
- I will keep the equipment in a safe area to prevent it from being lost, stolen, or damaged. If lost, stolen, or damaged I will promptly inform the TRiO SSS program.
- I agree to return the equipment to the TRiO SSS program on or before the return date. Failure to return the equipment will result in an academic hold and loss of my equipment rental privileges.
- I must reapply each semester to rent program equipment.
I acknowledge I have read and agree to the terms and conditions stated above:
Staff Name
First and last name of the staff member assisting
Revised: 08.26.2024
Should be Empty: