PERSONAL INFO

    First Name      Last Name      Room #      Dept  Select Dept Admin Math LA Sci SocStud SpecEd Fine Arts Tech Athletics Other

COMPUTERS

     Teacher  Workstation

       Select Model Dell Laptop Dell Desktop Fujitsu Laptop Other          Serial #       TISD FA #  

    Additional teacher computer (if applicable)

      Select Model Dell Gateway Other            Serial #       TISD FA # 

     Gateway  Student Workstations     0 1 2 3 4 5 6 7 8 9 10 11-20 21-30 31 or more          Dell  Student Workstations 0 1 2 3 4 5 6 7 8 9 10 11-20 21-30 31 or more

ADDITIONAL EQUIPMENT

(Please check box and fill in serial number if you have any of the following items)

      Data Projector           Select Model Epson Hitachi          Serial #         TISD FA #  

     Document Camera    Select Model ELMO LUMENS          Serial #        TISD FA #  

      Printer                           Select Model HP EPSON Brother Other          Serial #        TISD FA #  

     Digital Camera           Select Model Sony Kodak Casio Other           Serial #        TISD FA #  

      Video Camera            Select Model Sony Other           Serial #        TISD FA #  

     Scanner                        Select Model HP Canon Other           Serial #          TISD FA #  

     CPS Unit                      Serial #        TISD FA #  

      SMART Board           Serial #        TISD FA #  

     Other (List any additional equipment)  
           

ADDITIONAL NOTES   (List any repairs needed here also)

    

   I would like to check out the following equipment over the summer break: (Check all that apply.)

         Laptop          Projector          Digital Camera          Video Camera

________________________ If you are checking out any equipment, please PRINT
                            Signature                                           a copy and sign to turn in during final checkout.
                                         

_______________________   Date checked out __________________, 2009
                        Glenn English
     Hubbard Instructional Technology
 

    ** Before you click the SUBMIT button, please PRINT a copy of this page for your own records.