ITS HELPDESK / SOFTWARE SUPPORT

LAPTOP COMPUTER CHECK-OUT AND RESPONSIBILITY AGREEMENT

Date ________________________

Employee Name ______________________________________________________________________
                                  (Please Print)
Laptop/Device Tag No. __________________    Books/Accessories ______________________________

Software _____________________________   Estimated Replacement Value ______________________  

Department ___________________________   Work Phone No. ________________________________

Request Dates ________________________      ____________________________________________
                       From                                                 To 

Date Taken ___________________________    Date Returned _________________________________

Defects, damage, or known problems with equipment and/or software at time of check-out:

___________________________________________________________________________________

___________________________________________________________________________________

The equipment described above is assigned to the user for the purpose of instruction, demonstration, research, or general College support, directly associated with an authorized College activity.

THIS EQUIPMENT IS SUBJECT TO RETURN ON DEMAND

I, __________________________ , understand that I may be responsible for any costs for repair of damages incurred or replacement due to loss or theft of the above piece of equipment while it is in my possession.  I agree to return this equipment on ______________________.

I agree not to alter, delete or copy any software loaded on this computer.  I agree not to load additional software or to alter the existing configuration.  This equipment will not be used illegally.

I have read and understood the CNM Laptop Policy and the CNM Technology Use Policy.  I agree to follow these policies and the above stipulations.

Employee Signature _____________________________________   Date ________________________

==================================================================================

Condition upon return:    Unauthorized installation of software?     [   ] Yes [   ] No

                                    Unauthorized reconfiguration?                [   ] Yes [   ] No

Describe any damage to laptop computer or software:

__________________________________________________________________________________

__________________________________________________________________________________

The laptop, software, and/or accessories have been returned in the above condition.

Employee Signature _______________________________________ Date________________________

ITS Signature ___________________________________________  Date________________________