Equipment Check-Out Form

Equipment Check-Out Form

Please request all items at least 72 hours in advance
Name

First Name Last Name
Email
example@example.com
Phone Number

Area Code Phone Number
Equipment requested:
Date of pickup

Month Day Year
Date
Date of return

Month Day Year
Date
Purpose of the equipment requested:
Location where equipment will be used
Course/Event in which equipment is to be used
By submitting this form I understand that I am responsible for the well being and security of this equipment that I am using for the above listed course or event. Any damage or loss of this equipment can result in a charge to replace or repair the equipment checked out from the Center for Simulation and Experiential Learning. Submitting this form does not guarantee approval of the equipment request.
Should be Empty: