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Name First Last
Email
Date Requested * MM / DD / YYYY
Date to be returned * MM / DD / YYYY
This request is part of the MCL iPad Initiative.

Once per year MCL offers a limited annual iPad initiative to selected tenure-track and lecturer faculty. This program is only open for applications within an announced application cycle. Selections are based on proposed used of the iPad and approved through the LARC Advisory Committee. *
Yes, this is an application for this program. No, this is a regular short-term use request.
Purpose for Request *
Just interested in trying it out Conference attendance/Travel Exploration for instructional use
What interests you about the iPad? (Please check all that apply.) *
Portable web-browsing and email access Multimedia use (video/audio viewing/listening) Games/Entertainment Organization/Time Management eBooks and Reading Videocoferencing (Facetime/Skype)
Please briefly describe how this iPad will be used. *
I understand that I am responsible for this device and will be held accountable for any loss, including theft and damage. The complete replacement cost of the iPad is $500. *
I agree I do not agree
I understand that I will be required to turn this equipment back into the LARC at the end of check-out period. *
I agree. I do not agree.
Thank you very much for your iPad request. Trish Nolde will contact you within two working days to discuss your request.
Do Not Fill This Out