Equipment Loaner Program Form

Equipment Loaner Program Form

To reserve the loaner equipment, you must read and complete this form. Be sure to fill out all of the information. Once approved, you will receive an email with pick-up instructions.

Graduate Student Name

First Name*

Last Name*

UVA Email*

UVA Office Location

Equipment Loaner Agreement

Date From*

Date To*

Equipment Requested

Laptop (PC)

Agreement

Financial Responsibility: The graduate student must agree to accept full financial responsibility for the costs associated with repair and/or replacement of the loaner equipment if it is damaged, lost, or stolen. If the loaner equipment is damaged, lost, or stolen, the student will be required to notify the department immediately and work with Campus Police as deemed appropriate.

Acceptance

By submitting this form, I am accepting the responsibility outlined here and in the Departmental Provision of Loaner Laptop Computers program description. The Program Description can be found here:

Send me a copy of my responses

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