Loaner Equipment Check Out 19-20
* Required
Email address
*
Your email
Last Name
*
Your answer
First Name
*
Your answer
Home Address
*
Your answer
Date equipment is being checked out
*
Your answer
Anticipated return date
*
Your answer
Dell laptop computer (plus cord) or ChromeBook SERVICE TAG NUMBER
located on bottom of computer (not the express service code!)
Your answer
Computer Model
example: Latitude E6410
Your answer
Laptop/ ChromeBook condition
(excellent, good, or poor - please list ANY problems)
Your answer
Apple iPad SERIAL NUMBER
located in Settings - General - About - Serial Number
Your answer
iPad condition
(excellent, good, or poor - please list ANY problems)
Your answer
I understand that, by completing and signing this form, I assume financial responsibility for returning the borrowed equipment in the condition in which it was received. I further understand that I cannot use such equipment for purposes of personal gain or profit per District Regulation EDB-R
*
(please answer yes!)
Your answer
Send me a copy of my responses.
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