Authorization Form for Digital Equipment

Authorization Form for Digital Equipment

This form must be completed by a faculty or staff member prior to a designee
picking up equipment from Learning Support Services.

You can print this form by clicking on the printer icon located in the upper right corner of the page or click here for MS Word document.

The following person has been authorized by me to pick up/deliver equipment
for instructional or events use.

Name _____________________________________________

Email Address ______________________________________

Dates of Authorization:

From:  ____________________ To: ____________________

Approved by:

Name _____________________________Phone __________

Email Address ______________________________________

Date of Approval ___________________________________

I understand that I am responsible for the equipment use and return
at the designated time.

________________________________        ____________________________
Signature of Faculty/Staff Member             Date of Approval