Advanced Learning Center Equipment Reservation and Check-Out Form

ALC Staff Member ______________________________Date of call or contact_________________________________

Reservation Section:
Please fill this section out at time of first contact or phone call:

Faculty Name ____________________________ Department ___________________________________

Office Phone _____________________________ Email or other phone ___________________________

Date of pick-up ___________________________ Time of pick-up _______________________________

Date of return ____________________________ Time of return _________________________________

[Is extension beyond 30 days requested? __________________ Approved by ___________________________]

Equipment Requested (include details such as specific OS or peripherals if needed):

_______________________________________________________________________________________

If going off-campus, location of equipment: ___________________________________________________________

*Special Considerations (such as additional software to be added before pick-up): ______________________

Check-out Section:
Please fill this section out when equipment is picked up by faculty member:
Equipment Checked-Out:
ITEM___________________________UM Sticker ID ___________________________________________

_______________________________________________________________________________________
Faculty Members-- Please read and sign below:

+Faculty members checking out equipment are responsible for pick-up and return at the designated time, and will keep the
equipment secured and in their care at all times. Please be aware that these items are at high-risk for theft: do not leave
equipment visible in your car or office.

+Please be aware of the sensitive nature of technical equipment and do not leave it in your car or anywhere excessively
hot or cold.

+ ALC policy is to check-out equipment only to the faculty member unless other arrangements are made in advance.

+Faculty can check out equipment for 30 days unless a longer time period is reserved and approved in advance (see
above).

+Faculty needing more than 2 items will need approval in advance. A list will be attached to this sheet.

+Equipment is checked out for educational use only.

+Please inform ALC staff of any problems with equipment. Other suggestions? Email us: alcsupport@memphis.edu

_________________________________ ____________________________
Signature ALC Staff Member SIGN upon Check-out.

_________________________________ ____________________________ Date ______

Print Name ALC Staff Member SIGN upon Return.