OFF-CAMPUS USE OF EQUIPMENT
				AUTHORIZATION FORM
	Employee
	Name:         ____________________________________  Phone:____________________
	Address:      ______________________________________________________________
	Reason:       ______________________________________________________________
	Signature:    _________________________________ Date: ________________________
	Equipment
	Asset ID #:   _______________________________ Serial #: _______________________
	(Asset ID # may be omitted if the department tracks equipment by Serial #)
	Description:  ______________________________________________________________
	Condition:    ______________________________________________________________
	Authorization (by department head or designee)
	Name:         _______________________________________________________________
	Title:            _______________________________________________________________
	Signature:    __________________________________ Date: ________________________
	Fill out the following information when the employee returns the equipment.
	Receipt of equipment (by department equipment custodian)
	Condition:    _______________________________________________________________
	Name:         _______________________________________________________________
	Title:           _______________________________________________________________
	Signature:    _________________________________ Date: ________________________