UNIVERSITY OF ALASKA
AUTHORIZATION FOR OFF CAMPUS USE OF
UNIVERSITY EQUIPMENT
Description: _____________________________________________________________________
Property Tag #: ___________________________ Serial #: _______________________________
Campus: _________________________________ Department: ___________________________
Name: ___________________________________ Address: ______________________________
City: ____________________________________ State: _________________ Zip: ____________
Home Phone: _______________ Work: _______________ email: _________________________
Reason for off Campus use: _______________________________________________________
Location of equipment while off campus:
Date equipment will be returned to campus: ___________________________________________
Date equipment was checked out: ___________________________________________________
Equipment check out/received by (signature):__________________________________________
THE RETURN DATE MUST NOT BE LONGER THAN THE TIME REQUIRED TO
COMPLETE THE UNIVERSITY PROJECT BUT IN NO CIRCUMSTANCE LONGER
THAN 1 YEAR
_____________________________ _______________
Approving Signature Title Date
APPROVAL MUST BE FROM SUPERVISOR OR HIGHER LEVEL AS PRESCRIBED BY
YOUR CHANCELLOR OR VICE PRESIDENT
Form retention:
1. Original authorized form will be retained by employee removing equipment from campus.
2. A copy will be retained by the person authorizing this form.
3. A copy will be retained by the office where the equipment is normally kept.
__________________________________ ____________________________________________
Date equipment returned to campus Property check in/ received by (signature)
Comments
________________________________
____________________________________________
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