Application for JUSTICE Project IPad Loan
Upon completing this application, please click on the link below to print the Technology Equipment Borrowing Policy and Loan Form. Please print form and return completed application to the Help Desk located in the library.
Students Identification Number:
Your current status at Canisius:
Please only check one.
Childhood/Early Childhood Teacher Candidate
Childhood/Special Education Teacher Candidate
Early Childhood/Special Education Teacher Candidate
Early Childhood Teacher Candidate
Childhood Teacher Candidate
Special Education/Adolescence Teacher Candidate
Advanced Special Education
Full-time Faculty Member
Adjunct Faculty Member
Type of Program Currently Enrolled:
Teacher Candidates MUST complete this. Faculty are not required to answer this.
Describe how you would like to use the iPad and for what purpose:
Please limit your response to 500 words.
In what type of setting do you intend to use the iPad?
(For example, college class, P-6 classroom, for research, etc.). Include the grade level of the students that you intend to use the device with.
Give a brief description of the P-6 students you plan to use it with. Will any of these students have high-incidence disabilities (ex: learning disabilities, ADHD, speech-language impairments, other health impairments, emotional and behavioral disorders, etc.)
Which Apps do you plan to utilize?
(Please note: you may download apps from your own iTunes account, however, they may be deleted upon return to the Help Desk. If you recommend the JUSTICE Project invests in them, please submit recommendations on the feedback form upon completion,. Thank you!
Duration of time requested to borrow the iPad:
Short term (4 days)
Long term (4 weeks)
When would you like to be able to sign out the iPad?
(Please give an exact date).
I understand that by borrowing the iPad I agree to complete a brief evaluation form at the end of the borrowing period documenting how I used it and any recommendations I may have for future app purchases.
Yes, I agree to the following condition.
No. I do not agree to the following condition.
I understand that I am responsible for damage or loss of the above equipment while it is in my care, custody, and control.
Please check the appropriate box:
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