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