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ADE Assistive Technology Short-Term Loan Library Loan Request Form

ADE Assistive Technology Short-Term Loan Library Loan Request Formwebmaster2022-10-06T16:36:02-07:00

CONTACT INFORMATION

Borrower Name(Required)
Mailing Address(Required)
(Use street address for delivery, not a PO box.)
Email(Required)
(if applicable)
(if different from above)
Ship / Pickup(Required)

Item(s) requested

(Include components such as key guards. For questions about items in the Loan Library, call AT Loan Library at 602-776-4659 or 800-477-9921)
Items(Required)
Click the + button to add up to 5 items
Item Name
Inventory ID Number
 
Purpose of Loan(Required)
(Select primary reason.)
School Environment(Required)

Borrower Information(Required)

Is this your first time borrowing from the library?(Required)
How did you hear about us?(Required)

Is your request the result of attending an ADE training?(Required)
Agree to Terms(Required)
Type your full name to digitally sign this form.
This field is for validation purposes and should be left unchanged.

As approved ADE Loan Library borrowers, we agree to:

Assume responsibility for returning equipment by the stated due date. Usual loan period is 4 weeks. (Equipment MUST be returned in its original packing container using the prepaid shipping label in order for the library to efficiently track late, lost, or damaged equipment. This requirement is both for your protection and ours. Failure to return equipment on time may result in late charges.)

Obey software and other copyright laws. We willnot make copies of borrowed books, videos, software, and other copyrighted materials. We will remove borrowed software programs that were temporarily installed on any of our computer hard drives prior to returning the original software to the Loan Library.

Follow all stated procedures for requesting equipment from the Loan Library. Immediately notify AT Loan Library at 602-776-4659 or 800-477-9921 or at ATLoanLibrary@Nau.Edu if equipment malfunctions or ceases to operate. No attempts to repair malfunctioning equipment will be made without authorization.

Assume responsibility for the cost of repairing equipment damaged as a result of abuse, neglect, or carelessness. Reimburse the ADE Loan Library at current market value, if the equipment is lost, stolen, or damaged beyond repair.

Acknowledge that this agreement is in effect for up to one (school) year period and must be renewed annually.

Return all equipment by the end of the school year regardless of due date.

Complete the Short-Term Loan Library Feedback Form.

Have our Loan Library privileges suspended or revoked if we do not abide by these requirements.

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The Arizona Technology Access Program (AzTAP)
Northern Arizona University
300 W. Clarendon Ave, Suite 475
Phoenix, AZ 85013
602-728-9534
Fax: 866-463-9390
Toll-Free: 1-800-477-9921
NAU Northern Arizona University Institute for Human Development
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