REACH Equipment Loan Application

If you see this don't fill out this input box.

*First Name

*Last Name

*Date of Birth

*Mt. SAC ID Number

*Mt. SAC Email Address

*Driver's License Number or State ID Number

*Phone Number

*Street Address

*City

*State

*Zip Code

Equipment Requested

Laptop

Tablet

Calculator

Headphones

*Return Date

Please checkmark the following statements to indicate that you have read, understand and agree to the following terms of the Mt. SAC Equipment Loan Program.

Providing a Copy of your Class Schedule

I understand I will need to provide a copy of my class schedule before receiving the equipment

Returning Equipment if Class is Dropped

I understand that if I drop my class, I will need to return the equipment as soon as the class is dropped

Disqualification from future equipment loans

I understand that failure to follow this agreement may disqualify me from future equipment loans

Active REACH student status

I understand that I must be an active REACH student in order to be eligible to borrow REACH equipment

Three unit minimum requirement

I understand that I must be enrolled in at least 3 units to be eligible for the REACH equipment loan program

72 hour deadline

I understand that I must return the equipment to the REACH office no later than 72 hours from the time of check out

Signature of Approval

By checking this box, I acknowledge the terms set above

*Today's Date

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