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Liberal Arts and Engineering Studies Program

Freedom to Choose / Freedom to Create / Freedom to Travel

LAES Equipment Request Form

LAES Lab Managers oversee all equipment and activities in the lab. Some equipment (camcorders, cameras, recorders, microphones, etc.) can be checked-out for short periods to help students, faculty, and staff with class projects and activities. (Please provide a minimum of two-days notice for coordination.) Providing all the information requested on this form will assist in getting the equipment to you when you need it.

You will be required to submit an Off-Campus Authorization Form accepting responsibility for the equipment; if you need assistance completing this form, feel free to contact us.

Contact Information

What is your name? *

What is your Cal Poly email? *

What is your phone number? *

If student, what is your major?

If faculty/staff, what is your department?

Equipment Information

What is the name or topic of your project/activity? *

If you are a student, who is the supervising faculty/staff member?

When do you need the equipment? *

Month

Day

Year

Note: Check-out date defaults to 2 days from today, which is the minimum notice reqired for coordination. Please adjust this date to when you wish to pick up the equipment.

When will you return the equipment? *

Month

Day

Year

Note: Return date defaults to 3 days from your pick-up date. Please adjust to the date you will return the equipment, keeping in mind that others may be waiting for it's return.

How do you plan to use this equipment? *

Note: If you select "Other," tell us what the activity is in the Special Request/Comments box below.

Who will approve the Off-Campus Authorization Form? *

Note: If you select "Other," provide the name of an approved signer in the Special Request/Comments box below.

What equipment do you need and how many of each?

	One	Other
Camcorder	Camcorder - One	Camcorder - Other
GoPro Camera	GoPro Camera - One	GoPro Camera - Other
Pico Projector	Pico Projector - One	Pico Projector - Other
Nikon Digital Camera	Nikon Digital Camera - One	Nikon Digital Camera - Other
Roland Handheld Recorder	Roland Handheld Recorder - One	Roland Handheld Recorder - Other
Headphones	Headphones - One	Headphones - Other
Tripod	Tripod - One	Tripod - Other
Microphone	Microphone - One	Microphone - Other
Other	Other - One	Other - Other

Note: Mark all that apply. If you select "Other," tell us what you need in the Special Request/Comments box below.

Special Requests/Comments/Questions.

Leave this field blank

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LAES Equipment Request Form

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