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Information Technology Equipment Check-Out Form
  
 
Name *

First
Last
Your Email *
Department *
Department Head *
Phone Number *

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Equipment Needed (Check all that apply) *
Pick-up Date and Time

MM 		/
DD 		/
YYYY
HH 		:
MM
AM/PM
Return Date and Time

MM 		/
DD 		/
YYYY
HH 		:
MM
AM/PM
Other Comments
Purpose for Borrowing Equipment
Location Where Equipment Will Be Used
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