Employee's Name * Employee's Email * Department * Email of person authorizing the use of property off-campus * Item #1 Property Tag/Device Name Serial Number Description Item #2 Property Tag/Device Name Serial Number Description Item #3 Property Tag/Device Name Serial Number Description Item #4 Property Tag/Device Name Serial Number Description Item #5 Property Tag/Device Name Serial Number Description Item #6 Property Tag/Device Name Serial Number Description Date of Check Out * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202120222023 Date Property to be Returned * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20212022 This form is valid for one year only, please make sure your return date is within this time frame. Justification for Using Property Off-Campus * Primary Off-Campus Location at which property will be used *
