Equipment Check-Out Form printable pdf download

Equipment Checkout Form 

Carleton College 

Psychology Department 

Student Name: ___________________________________________________  Class Year: _______________ 

Equipment to be checked out:  ________________________________________________________________ 

______________________________________________________________________________________________________ 

Reason for Checkout (place check‐mark on appropriate line and complete adjacent info.): 

_______  Comps     

Advisor:  __________________________________________________ 

_______  Independent Study    

Supervising Professor:  __________________________________ 

_______  Other   

Explain: ___________________________________________________ 

Approved By: _____________________________________________________________________________________ 

CheckOut Date: ____________________________   

Return By Date: __________________________ 

STUDENT AGREEMENT: 

I agree that I, (print name) _____________________________________, am responsible for the care 

and maintenance of the equipment described above for the duration of the time it is in my 

possession. Should any damage or malfunction of the above equipment occur while in my 

care, I agree to be financially responsible for repair or replacement of the equipment. I also 

agree to return the equipment as scheduled, and should I need an extension of the check‐

out period I agree to request and gain approval for that extension before the "Return By 

Date" listed above.  

SIGNED: ___________________________________________________________  DATE: ___________________ 

Equipment Check-Out Form