Equipment Loan Request Form (original) (raw)

Equipment Loan Request Form

MTSU's Adaptive Technology Center (ATC) has a wide range of adaptive technology equipment available to borrow by students with a documented disability. Equipment ranges from video magnifiers to track ball mice to audio recorders and much more. Browse through the sections on the next page to determine whether our AT equipment can fill a need for you.

Please note: Equipment is checked-out to students on a first-come first-serve basis. We unfortunately have a limited supply of each listed item.

Are you registered with MTSU's Disability and Access Center?

Registration status with MTSU's Disability and Access Center: *

Yes, I am registered with DAC.

Required

Phone *

Example: 615-555-2512

What type of equipment would benefit you? *

Tell us a little about how we can help. *

Never submit passwords through Google Forms.