Device Request form for the Northern NJ CS Hub Lending Library
Please use this form to request a loan from the Lending Library at the Northern NJ CS Hub. Prior to submitting this form, please ensure you read the information on the loan process at www.northernnjcshub.org/lending-library
Sign in to Google to save your progress. Learn more
Email *
Secondary Email
We recommend adding more than one email to ensure that communication is received.
 *
What is your first name? *
What is your last name? *
Cell phone number *
What is your title or role? *
What grade(s) do you teach?
What subject(s) do you teach? *
What is your district? *
What is the name of your school? *
What is your administrator's first name?
If you are an administrator placing this request, please note that here.
 *
What is your administrator's last name?
If you are an administrator placing this request, please note that here.
 *
What is your administrator's title?
If you are an administrator placing this request, please note that here.
 *
What is your administrator's email?
If you are an administrator placing this request, please note that here.
 *
Please select the type of Device you are requesting. *
How many devices would you like to request? *
Please indicate your preferred date for pick up. (We will contact you to confirm the actual day of pickup)
We recommend at least 2-3 business days in between request and pick-up.
 *
MM
/
DD
/
YYYY
What times would you be most available for pickup? We have a part-time staff so please give us some options to work with.
Please indicate your preferred date for RETURNING the borrowed item(s). *
MM
/
DD
/
YYYY
Additional notes or comments
By completing this form, you are committing to participating in our lending library program, should your application be fulfilled. This means you understand that if all items are not returned in the same condition as they were when borrowed, or if you do not return the items by your designated deadline, you will be held liable for paying up to the full purchase cost of the resources lent out to you. *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms