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Equipment Request Form
STUDENT DIVERSITY INITIATIVES EQUIPMENT CHECKOUT FORM
Email Address
First Name
Last Name
Student Organization
Checkout Date/Time (ex. Jan. 1, 8am)
Return Date/Time (ex. Jan. 5, 2pm)
Items Available to checkout
Items Available to checkout
Projector
Coolers
Water Jug
Cooler Cart
Sleeping Cot
Board Games (please specify name of game below)
Outdoor Games (please specify item below)
Craft Supplies (scissors, glue guns, rulers, pencils, extension cords) (please specify item below)
Glass centerpiece vase (specify quantity needed below)
Karaoke Machine
Description of item requested:
Quantity of each item needed
Purpose of Request
Location of Use (Be specific)
If off campus reason for off campus use:
MoCode (Replacement/Repair fees may be charged for broken or lost equipment up to the cost of the equipment)
I UNDERSTAND THAT I AM RESPONSIBLE FOR THE EQUIPMENT WHILE IT IS CHECKED OUT TO ME. IT MAY BE REMOVED FROM CAMPUS ONLY FOR OFFICIAL BUSINESS OF THE UNIVERSITY. WHEN IT IS REMOVED, THE INDIVIDUAL REMOVING IT ASSUMES RESPONSIBILITY. I MAY ALSO BE CHARGED A FEE FOR THE REPAIR OF ANY DAMAGE THAT OCCURS TO EQUIPMENT WHILE IN MY POSSESSION. I WILL REPLACE ANY BOARD GAME OR OUTDOOR GAME IF DAMAGED OR MISSING ANY PIECES. BY FILLING IN THE SPACE BELOW I AGREE TO THE STATEMENT ABOVE.
Student ID
Submit
Missouri University of Science and Technology
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