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Luskin Computing Services Equipment Checkout Form

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Luskin Computing Services Equipment Checkout Form (Revised 03/2014) Date: Location: Course/Event: Repeat: Weekly on ☐ M ☐ T ☐ W ☐ R ☐ F End Repeat: Instructor/Supervisor First: Last: Phone: Office: Borrower Email: Checkout By ☐ Faculty ☐ Staff ☐ Student First: Last: Phone: UID: Email: Date: Time: Equipment Please place the quantity in ( ☐ ☐ ☐ ☐ Laptop and Charger ( ) ) Presentation Remote w/ Laser ( Mac VGA Adapter ( ) ) VGA Cable with Sound 3ft ( ) ☐ ☐ ☐ ☐ HDMI Cable 6ft ( ) HDMI Cable 12ft ( VGA Cable 6ft ( ) ) Other:(specify) Acknowledgements I understand the following conditions for borrowing this equipment: ☐ I will surrender my BruinCard until the equipment is returned. ☐ Equipment is provided for educational-related use only. ☐ Equipment must be returned before 5:00pm on the return date. I accept full responsibility for the equipment I am borrowing. In the event of loss or damage of the equipment, I will report the circumstances of that loss or damage to the Help Desk immediately. I agree to return the equipment promptly. Signature of Borrower: O ff ic e Us e O n ly Return Date / Time: Approved By: Check In All items returned in satisfactory condition: ☐ Yes ☐ No (If not, note any problems). ☐ BruinCard returned to borrower Date Returned: For questions or concerns please contact the Help Desk Received By: Phone: (310) 206-6767 Email:[email protected]