Assistive Technology Loan (Non-Rutgers)

By accepting the loan of the equipment described below, you agree to the following:

I am a student with a documented disability.
I am responsible for maintaining the equipment in the same condition in which it was loaned.
I will return the equipment to the ODS for repairs and/or replacement if it malfunctions.
I am prepared to return the equipment upon request.
I will return all equipment at the end of the academic year to the ODS.
I am financially responsible for any loss or theft of equipment.

First Name *

Last Name *

RUID *

Email address *

Phone *

Campus *

ODS Staff Loaning Out Item *

Office ID of equipment *

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