Equipment Loan Agreement - Disability Services Program (Dsp) printable pdf download

Equipment Loan Agreement - Disability Services Program (Dsp)

Equipment Loan Agreement

Disability Services Program (DSP) – Merritt College

You must have the recommendation of a DSP Counselor to qualify for certain

equipment based on your documented disability.

You are responsible if the equipment is damaged, lost, or stolen, even if it is

not your fault.

If the equipment is not returned, or is damaged, you are responsible for full

replacement value.

If you do not return the equipment in working order, or pay for it, a HOLD

will be placed on your registration, transcript, and all transactions.

Equipment Loaned: ____________________________ Date: ___________

Replacement Value: $ _____________ Deadline for Return: ____________

Condition on check out: _________________________________________

I: ______________________________________ agree to the above terms.

Signature: _________________________ Student ID: ________________

Email: ______________________________ Phone#__________________

Checked out by DSP Staff: _______________________ Date: __________

Returned: _________ Condition on return: __________________________

Released of responsibility: ______________ or Charges Due: $ _________

_____________________ /_______

___________________ /_______

Student Signature

Date

Received by DSP Staff

Date

Equipment Loan Agreement - Disability Services Program (Dsp)