Golden West College Accessibility Center for Education STUDENT EQUIPMENT

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					Golden West College Accessibility Center for Education STUDENT EQUIPMENT/BOOKS ON CD LOAN AGREEMENT
Name: _____________________________________ GWC ID #: ___________________________ Address: ___________________________________ City: __________________ Zip: ___________ Phone: (_____) __________________ E-Mail Address: ___________________________________
Staff Use Only: Equipment: Item Serial Number

All Equipment/Books on CD are Due: _______________
Condition of Equipment Date Out Date Returned Staff Initials

Books on CD: Title of Book Author
RFB&D or No. of CDs

Date Ordered

Date Rec’d

Date Returned

Staff Initials

Tien

Books Ordered by:

I agree: (1) to return the equipment/books on CD in the same condition as when received from the Accessibility Center for Education Office; (2) to pay for any damage or loss incurred through negligence or lack of control of the equipment/books on CD; (3) to pay for any corrective action taken to restore or replace the CD’s and, or piece(s) of equipment to the original condition upon return; (4) to not loan the equipment/CD to any person; and (5) to return equipment/CD no later than the “Due Date” listed above. I further understand that if the equipment is not returned on time, or the damage/replacement fees are not paid, access to my official records and enrollment will be denied until the fees are paid or the item(s) is returned in working order.

Student Signature: __________________________________ Date: _________________________

C:\Documents and Settings\ttran\Desktop\website\Student Equipment Loan Form2.doc 4/16/2008


				
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