Home Use Permit
Authorization for Off Campus Use of CSUCI Equipment
T&C Services
One Univ
ersity Drive
Camarillo, CA 93012
Phone (805) 437-8402
judy.frazier@csuci.edu
Recipient of Equipment: ___ Faculty * ___ Staff ___ Other ______________________
Employee Name: _______________________________________________Department: _____________
Employee’s Building/Office Location: _____________________________Office Phone: ____________
Equipment Description: _________________________________________________________________
Serial Number: ________________________________ Asset Tag Number: _______________________
I accept responsibility for the CSUCI equipment, listed above. I understand the following terms and conditions:
University equipment is to be used only to conduct University business.
Any unauthorized use of the equipment is prohibited.
Upon separation of employment, I agree to complete the established campus separation and
clearance process and assume financial responsibility for any unreturned equipment.
I am required to keep a copy of this form with me whenever transporting the equipment as I may
be asked to provide proof of permission to remove it from the University.
Contact Property Coordinator for any returns and/or exchanges of equipment.
Information Technology Policies apply to all users of University computers, regardless of
location. Policies can be read online or downloaded from http://www.csuci.edu/it/policy.htm. Pay
special attention to policy on Confidentiality and Security.
_________________________________
___________________________________
Employee – Print Name Signature Date
_________________________________
____________________________________________
Superv isor – Print Name Signature Date
* Supervisor of record for all faculty is the Dean/Assoc. Dean of Faculty
Please keep a copy of this form with the laptop & return the original form to Judy Frazier in the T&C
Department.
For Property Coordinator Use Only:
Date Returned/Exchanged: ___
________________________________________________
New Location and/or New Disposition: _________________________________________
