School Computer Checkout Form
Complete this form to borrow a computer from the school. Please provide accurate information and review the terms of use.
Borrower's Full Name
*
First Name
Last Name
School Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Affiliation
*
Please Select
Student
Faculty
Staff
Other
Device Type
*
Please Select
Laptop
Desktop
Tablet
Other
Device Model
*
Asset Tag or Serial Number
*
Accessories Checked Out (select all that apply)
Charger/Power Adapter
Mouse
Carrying Case/Bag
Other
Condition of Device at Checkout
*
Please Select
Excellent
Good
Fair
Poor
Checkout Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Expected Return Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Borrowing the Computer
Borrower's Signature (sign below)
*
Submit Checkout Request
Submit Checkout Request
Should be Empty: