Equipment Checkout Form

1
Device Type?* This field is required.
Laptop
Desktop
Tablet
Chromebook
2
Asset Tag* This field is required.
3
Includes?
USB C 4 in 1 Adapter
Power Adapter
Dell Dock 130W
External Monitor
Tablet Case with Keyboard
4
School or Site Name* This field is required.
Ann Sobrato High School
District Office
Barrett Elementary School
Britton Middle School
Central High School
Community Adult School
El Toro Elementary School
Jackson Academy
Los Paseos Elementary School
Live Oak High School
Martin Murphy Middle School
Nordstrom Elementary School
Paradise Valley Elementary School
P.A. Walsh Elementary School
San Martin/Gwinn Elementary School
5
Department
Transportation
Food Services
Technology
Migrant Education
Educational Services
Human Resources
Finance/Payroll
Student Services
Enrollment
Special Education
Facilities/Maintenance
Grounds
Superintendents Office
6
Room # or Office
7
Full Name* This field is required.
First Name
Last Name
8
E-mail* This field is required.
example@mhusd.org
9
Date Checked Out* This field is required.
Date
Month
Day
Year
3
1
2
3
4
5
6
7
8
9
10
11
12
Hour
16
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
AM
PM
10
* This field is required.
I understand that I am responsible for returning this device both in good working order and when asked to do so. I understand that I am to contact the Technology Department immediately if the device is lost or if it has any technical issues. If I use any personal software on the device, I understand that the device will be reformatted and any apps/software I purchased will not remain in my possession. I will be financially responsible if the device is not returned or willfully damaged.
Should be Empty: