LSHTM Open Data Kit - Device Request
This form should be used to request loan of Android devices, power packs and 3G Wifi dongles
Email address *
Your Details
Your Name *
Your answer
Project Name
Your answer
Please indicate the numbers of devices and powerpacks you need
Smart-Phone (Google Nexus 7)
Your answer
Android tablet (Google Nexus 5/Asus ZenPad 8)
Your answer
10,000 mAh power pack
Your answer
20,000 mAh power pack
Your answer
3G Wifi Dongle (sim free)
Your answer
Please indicate the expected dates for the loan period
Start Date
Your answer
End Date
Your answer
Principal Investigator / Line manager / Project Supervisor
Please give the name and email address of the principal investigator/ project supervisor of the study
ALL Students must enter the name of an LSHTM staff member who is willing to act as PI.
Principal Investigator Name
Your answer
Principal Investigator Email
Your answer
Faculty
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