Equipment Loan Request Form
Thank you for expressing an interest in our equipment loan program! Please complete this form to begin the equipment loan process. Once you have submitted the form, someone from the Educator Resource Center (ERC) will be in contact with you to confirm or deny your request. By completing this form, you are not guaranteed to have your loan approved. Please do not show up at NASA to pick up your kit if you have not received a confirmation email from the kit loan manager, or if your request has been denied.

By submitting this form I confirm I am at least 13 years of age and agree to the IV&V ERC Privacy Policy located at the URL: https://docs.google.com/document/d/1D0pC7Lf6KaPEYSaK71AJ48_C5GAvMQDWZKcVHB86xrY/edit?usp=sharing
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Contact Name *
Please provide the name that appears on the ID you will be using for security.
If you may have completed the kit training with a different last name, please put it below. 
E-mail Address
Phone Number
Contact Preference *
Required
Which grade level will the kit be used for?
Select County/School District *
Where are you located?
Equipment Selection *
Which kit/equipment are you requesting for a two week loan? (Please make one selection per form)
Suggested Pick Up Date *
MM
/
DD
/
YYYY
Suggested Return Date (Equipment loans are no longer than two weeks) *
MM
/
DD
/
YYYY
Please specify who will be picking up/returning the kit.
Please list all names of those who could pick up/return the kit. This is for security purposes. Please bring an ID to present to security upon arrival. You will not be able to pick up/return the kit if you are not on this list. Be sure to provide the name that will be on the ID used for security.
Pick Up Names *
Return Names *
Additional Information
By submitting this form you agree to the IV&V ERC Privacy Policy located at the URL: https://drive.google.com/file/d/1cvr1mhVJ0_gzAdRKY9dcm7UmILMUCFO1/view?usp=sharing *
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