ERC Item Request Form
Please complete this form before checking out any items from the ERC Reception Desk.

If you have any questions, ERC Assistants can be contacted by phone: (831) 459-2427 or email: ERCadmin@ucsc.edu

Email address *
Name: *
Your answer
Student ID # (or CA ID for staff/faculty): *
Your answer
Phone Number: *
Your answer
Resource Center Hosting the Event: *
Organization/Affiliation:
Your answer
Item(s) Requested: *
Required
Check-out Date: *
MM
/
DD
/
YYYY
Check-out Time: *
Time
:
Return Date: *
MM
/
DD
/
YYYY
Additional details about request:
Your answer
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