Military & Veteran Success Center Equipment Loan Request

Name Name * First Last
Student ID *
Must be 9 characters. Currently Entered: 3 characters.
Student Email *
Contact Phone Number Contact Phone Number - ### - ### ####
Type of Equipment requested: *

Type of Equipment requested: Digital Recorder Headphones Zoom Max Chromebook Other Other
Equipment Loan Terms

I agree to be responsible for equipment loaned to me and will return equipment to the Military & Veteran Success Center by the last day of the current semester or immediately upon my withdrawal of class(es). I understand failure to return equipment will result in a financial hold on my transcript, which will block registration for future semesters.

Any damage or loss of equipment must be reported immediately to M&VSC personnel. I am responsible for replacement or repair of equipment.
*

By checking this box, I agree to the terms described above.
Draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.