Request For Use Of University Property Off Campus Form
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1CLEAR FORM
REQUEST FOR USE OF UNIVERSITY PROPERTY OFF CAMPUS
Requested by: _________________________________ _________________________ ______________ _____________
(Name) (Dept. Name) (Index) (Bldg.)
I hereby request authorization to use the following Michigan Technological University property at:
________________________________________________________________________ Dates: From ____________to___________
(Address)
Item#
Description of Property
Serial Number
Inv.# or PO#
Tag#
1)
____________________________________________ ____________________ _______________ ___________
2)
____________________________________________ ____________________ _______________ ___________
3)
____________________________________________ ____________________ _______________ ___________
4)
____________________________________________ ____________________ _______________ ___________
Purpose : This property will be used for ___________________________________________________________________________.
I certify that the equipment listed above will be used for official University purpose. Damage or loss of this property must be immediately reported
to Dean, Director, or Department Chair, and Financial Services and Operatoins. I hereby acknowledge the receipt of the above listed property and
am aware of the responsibility for its location, care, and return. See below for notification of returned property.
Requestor: ________________________________________________________ __ ___________________________
(Dat e)
(Signature)
Authorization: Permission is hereby granted to the person listed above for the off‐campus use of the equipment listed.
Approved: _________________________________________________________ ____________________________
(Dean, Director, or Department Chair) (Dat e)
Approved: _________________________________________________________ ___________________________
(Financial Services ‐ Property Office) (Date)
Notification of Returned Property ‐ The property listed above has been returned to the University and is located in:
Item# (from above) Return Date
Location
__________ _________________ ______________________
__________ _________________ ______________________
__________ _________________ ______________________
__________ _________________ ______________________
Equipment Coordinator Verification
Authorization: I hereby certify that all the property listed has been returned in satisfactory condition to the above locations.
Equipment Coordinator: _________________________________________________________ ____________________________
(Signature)
(Date)
Please send completed form to Financial Services and Operations
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Parent category: Business