Student Laptop Computer Request Form printable pdf download

STUDENT LAPTOP – BORROWER RESPONSIBILITY FORM

LAPTOP NUMBER: ________

Yale University

Cushing/Whitney Medical Library

Name: __________________________________________________________________________________________________

Email Address: ______________________________________________________ NET ID: __________________________

School Affiliation: __________________________________________________ Class: ____________________________

The Medical Library offers students the ability to use MAC and PC loaner laptop computers at no charge as a

courtesy to students who are currently enrolled in the following schools: MED, PA, NURSING, PH, BBS. The

Library retains the right to deny a student use of this laptop if the student’s account has been blocked, or if they

violated the University’s Appropriate Use Policy. For fair use, laptops are non-renewable.

By initialing each of the statements below, I (the Borrower) agree to the following terms and conditions:

Initials

_______ I acknowledge that the loan of this laptop includes the laptop, the power supply,

mouse, and the case. I have verified that these items are included at the time of loan.

_______ I acknowledge that laptops may be borrowed for up to 5 days and are non-renewable.

Once the laptop is returned after five days, I agree to wait until the next day to borrow

a laptop again.

_______ I acknowledge that I am fully responsible for the security of the laptop and any

peripheral devices once borrowed. Should the computer and/or any peripheral devices

be damaged, lost, or stolen, I agree to pay up to $1,200 for their repair or replacement.

_______ I agree to pay a late fee of $10 per day, up to a maximum of $300. Computers 30 or

more days overdue will be considered lost or stolen, and therefore I will be responsible

for paying the replacement cost of $1,200.

_______ I agree to adhere to Yale’s Appropriate Use Policy. If I am unfamiliar with the policy, I

agree to read it in full (which is found on the laptop’s desktop and in the laptop case).

_______ I acknowledge that files saved to the laptop’s hard disk will be discarded once it is

returned to the Library. I understand that the Library is not responsible for any lost

files, or any loss or damage of any kind resulting there from.

_______ I agree to be the sole user of this laptop. I understand that lending or renting the laptop

to anyone is a violation of this contract.

_______________

________________________________________________

___________

Date

Student’s Signature

Staff Initials

Student Laptop Computer Request Form