Teacher/Staff Technology Checkout Form
Used by CCMS Faculty and Staff for Summer Break
Teacher / Staff Name *
Your answer
Date Checked out *
Technology being Checked Out *
Device Make and Model *
Your answer
Device Serial Number (Not LAUSD Barcode #) *
Your answer
The undersigned is checking out from CCMS the technology described above. The borrower agrees to return the technology in the same condition as when it was checked out. For a computer, this includes not altering the system folder or registry, not changing network settings and removing any software programs and personal data the borrower added during the checkout period. The borrower further agrees that the purpose for checking out the technology is for district personnel use only and to improve his/her technological skills or to complete a curriculum related project. *
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