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Technology Request Form 

By submitting this application the applicant agrees to the following:

1. I have read and understood the requirements for the Technology Resources Loan Program under the Technology Resources tab before completing an application.
2. I have reviewed technology availability under the Available Technology Resources tab before completing an application form.
3. I am aware technology resources must be picked up and returned in person with an APSU Student ID at the Latino Community Resource Center by the established deadlines.
4. I will be responsible for returning the technology in the same condition that it was in when I checked it out and I will sign technology back in with an authorized HCC employee.
5. I will be responsible for the payment of charges as a result of damages and/or loss of technology.
8. I am aware that if I return the technology after the due date that I will be banned from utilizing these services for 90 days after the return date. If a pattern of disregard for these rules is displayed, you may be permanently banned from utilizing these services.
9. I am aware that failure to comply with these requirements will result in a hold on my student account and/or I will be found in violation of the Student Code of Conduct.
I understand and agree with the above requirements.
Please provide a phone number that we can use to reach you regarding your rentals.
Select one term only.
I understand the technology must be returned by the end of the semester I requested it for.
Technology resource being requested: