PROPERTY CONTROL FORM NO. 7
Revised June 2014
STUDENT/FACULTY OFF CAMPUS USE OF STATE PROPERTY
DATE:
STUDENT/FACULTY NAME:
ADDRESS:
TELEPHONE NUMBER:
The following state property is periodically loaned, in conjunction with class work, to the above
referenced student/faculty member during the ________ semester, __________. By signing below, the
student or faculty member acknowledges that he/she shall be held responsible for any damage or loss of
equipment. Failure to reimburse the University for loss or damage, shall result in the indebtedness of
the student or faculty member to the University. In addition to this form, user shall sign a log sheet in
the LRC each time the equipment is taken off campus and returned.
DESCRIPTION OF EQUIPMENT:
__________________________________________
STUDENT/FACULTY SIGNATURE
APPROVED BY:
COURSE INSTRUCTOR: _______________________________________________________________
DEPARTMENT HEAD:_________________________________________________________________
DIRECTOR OF PROPERTY CONTROL:____________________________________________________
To be completed at the end of the semester, Student/faculty and department head shall sign
below acknowledging the return of all state property used during said semester.
__________________________________________
STUDENT/FACULTY MEMBER
__________________________________________
DEPARTMENT HEAD
NOTE: When completed, form must be forwarded to the Property Control Office.
