Science in Motion Equipment Request
Name
*
First Name
Last Name
Email
*
example@example.com
Emergency Phone Number
*
-
Area Code
Phone Number (Provide best number to use in the event of a last-minute emergency)
School Name
*
School District
*
Request Type
*
Lab Equipment Only
Lab Equipment and Lab Assistance
If needed, what type of lab assistance
Training on Equipment
Assistance during lab
Lab Assistance Date
-
Month
-
Day
Year
Date- Must be at least two weeks in the future. Last minute requests may need to be delayed depending on staff availability. SIM will be in touch to confirm best day for assistance.
Alternate Lab Assistance Date
-
Month
-
Day
Year
Date- Please provide a second date in case the requested date is not available
Equipment Loan Start Date
*
-
Month
-
Day
Year
Date: Must be at least two weeks in the future. Last minute requests may need to be delayed or not fulfilled depending on staff and equipment availability. SIM will be in touch to confirm the best day for equipment delivery
Equipment Loan End Date
*
-
Month
-
Day
Year
Date- SIM will be in touch to confirm the best day for pick-up
Equipment Requested: Enter the number and name of each piece of equipment needed. Find equipment lists on the SIM website. (e.g. 6 Vernier Dissolved Oxygen Probes)
Consumable Supplies Requested: Enter the number and name of each consumable needed. Find the consumables list on the SIM website. (e.g. 3 Daphnia cultures)
If you need electrophoresis gels, how many wells will you need and where should they be located?
6 wells in the middle
6 wells at the end
8 wells in the middle
8 wells at the end
10 wells in the middle
10 wells at the end
Acknowledgement
*
By checking the box, you are acknowledging that you have read and understand the following: An email will be sent to confirm your equipment delivery date and service. SIM asks for two weeks to process equipment requests. While the equipment is in your care, you are responsible for its safety. Normal wear and tear on borrowed equipment is expected. However, if equipment is purposefully damaged by students, a fee to fix or replace the equipment will be charged to the district. Please return all borrowed equipment in the same condition as you received it.
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