Equipment Checkout Form

Equipment Checkout Request

Veterans Upward Bound
Name*

First NameLast Name
E-mail*
example@example.com
Phone*
example: 406-***-****
Checked Out Resource*

CalculatorComputerWifi HotSpot
Computer or Asset Type
Check out date*

MonthDayYear
Date
Anticipated check in date

MonthDayYear
Notes
Student Loan Agreement

I understand that I am responsible for returning the resources I check out on the date due, normally at the end of the semester. Failure to do so will result in the loss of borrowing privileges. I also understand that I am responsible for preventing damage or theft to the resources while checked out to me. If the equipment is lost, damaged, or stolen, I will purchase a replacement at my own expense.
Should be Empty:

Equipment Checkout Request