Off-Campus Loan Form

When used for University business, University property may be loaned to University employees or another campus department to use on- and/or off-campus. For an item that is designated "off-campus" (to be used for other than business travel, ie. home use), an "Off-Campus" Loan form is required to be approved by the appropriate administrator (Level 3). Upon return of the loaned item, the department record keeper (DRK) acknowledges receipt on the form.
Complete the form and use the button below to display a printer friendly version.
Print the "Printer Friendly Version" of the form.
Sign the form and obtain the appropriate administrator signature.
The completed form is to be maintained by the department record keeper and is to be available for inventory and audit purposes as requested by the Property Management Office. A copy is to be provided to the borrower.

Fields with * are required.

BORROWER INFORMATION *Last Name *First Name

*Email Address

*Phone Extension *Campus ID#

PROPERTY INFORMATION

PURPOSE OF LOAN *CHECK ONE:

Instruction Research

Other (describe)

PERIOD OF LOAN (Specific dates)

*From date (mm/dd/yy): *Through date (mm/dd/yy):

By signing out for the property listed above, the borrower agrees to the following:

to use the property in the best interest of the University and for University business purposes only;
to assume responsibility for the custody of the property;
during the physical inventory process, to either bring in the property for physical view by the Property Management Office (PMO) or to acknowledge the item is in their possession and in good working condition by signing-off on the Physical Inventory Certification form.
to replace the property if it is lost, stolen, or damaged as a result of negligence;
to immediately report to the University Police Department and the PMO should the property on loan become lost, stolen or damaged;
to return the property by the agreed upon due date or upon separation from the University, whichever occurs first; and
that the borrower is not relieved of this custody until a signed copy of this form acknowledging the return of the property is returned to the borrower by the Department Record Keeper.

DEPARTMENT INFORMATION *DEPARTMENT ID *DEPARTMENT NAME

Borrower's Signature

Appropriate Administrator Signature

There are several reasons why the printer friendly version may not display

Acrobat Reader is required. If you do not have Acrobat Reader, click on Get Acrobat Reader to download this program for free.
Acrobat Reader is configured so that it does not display PDF files in the browser. To resolve this, open Adobe Reader. Select Edit->Preferences. Click on the Internet Category on the left side of the window. Place a check in the box next to "Display PDF in browser". Close Acrobat Reader.
Your Acrobat Reader installation needs to be repaired. To resolve this, click on Help->Repair Adobe Reader Installation. Close Acrobat Reader.
If you have any problems completing this form, please contact fmsupport@csulb.edu.