Fall 25 Tech Loaner Form

Student ID

Name

First NameLast Name

Phone Number*

MSU Email*

example@example.com

A separate form must be submitted for each request.

Please select which technology item you are requesting below:*

Graphing Calculator (TI-83)iClickerLaptop (Dell)Scientific Calculator (TI-30)

PLEASE READ THE FOLLOWING:

Student Responsibility:

I understand that the loaned technology is my responsibility while it is checked out to me. I will take all reasonable precautions to protect it. If others use it while it is checked out to me and damage occurs, I understand that I will be held liable for any loss, damage, or criminal acts that may occur.
I agree that I will be restricted from the TRIO SSS Technology Loan Program and a hold will be placed on my academic record due to any loss, damage, or theft of my technology.
I understand that if the device is lost or stolen I must notify the TRIO SSS Program Director in person, by phone 517-884-8466 or via email at jmrobin@msu.edu immediately and file a police report with the Michigan State University Campus Police. Replacement cost is $1,500.00 for the laptop and charger.
I understand that this agreement must be renewed each academic semester and that a loss of privileges will occur for a failure to comply with these policies and guidelines.

I acknowledge and affirm the following statements: I am currently enrolled as a student at Michigan State University and an active member of TRIO SSS. I understand that I am required to return my technology no, later than the last day of the current semester. I understand that this request is subject to technology availability.*

I am currently enrolled as a student at Michigan State University and an active member of TRIO SSS.I understand that I am required to return my technology no, later than the last day of the current semester.I understand that this request is subject to technology availability.

User Guidelines:

I agree to adhere to the terms and conditions outlined in the MSU Acceptable Use Policy For MSU Information Technology Resources including but not limited to licensing agreements, licensing grant restrictions, copyright restrictions and transfer restrictions.
I agree to adhere to use policies for uniform access computing as outlined by Michigan State University and other Student Technology Fee Laboratory restrictions or requirements.
I understand that the technology hard-drive is wiped after each use and anything installed or saved to the device will be erased. If I wish to save any data, it must be to an external USB drive or my network drive.

Liability:

I understand that Michigan State University or the TRIO SSS Program is NOT responsible for loss of data or damage to files that may occur due to the use of technology acquired from the TRIO SSS Technology Loan Program.

Sign Below to Acknowlegde you have read and undrstand the information provided above:

Student Signature

Date

TRIO Student Support Services (SSS)