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Modoc Joint USD |  E  3512  Business and Noninstructional Operations

Equipment   

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EQUIPMENT LOAN FORM

I assume the responsibility for the following district equipment:

Description ID Number

__________________________________________________________

__________________________________________________________

__________________________________________________________

School-related purpose: (Note: items are not for personal use)

__________________________________________________________

__________________________________________________________

__________________________________________________________

I will return the above equipment to_____________________________

(administrator or designee)

no later than _____________________________.

(date)

In borrowing the items listed above, I assume responsibility for any loss of or damage to the equipment or materials. If any items are damaged or lost, I will pay the cost of repairs or replacement.

Signed: _____________________________

Date: _____________________________

Approved: _____________________________

Date: _____________________________

Exhibit MODOC JOINT UNIFIED SCHOOL DISTRICT

version: September 19, 2006 Alturas, California