Laptop Loan Request Form Please enable JavaScript in your browser to complete this form.Literacy Network Staff Person or Intern: *Student Name: *FirstLastYou must complete the laptop loan agreement: *I agree to use the equipment in a legal and responsible way.I understand that the equipment is the property of Literacy Network.I will notify Literacy Network staff if there is any damage done to the equipment and return the damaged equipment to Literacy Network.I will remove all personal files from the device before I return it.I will return the equipment to Literacy Network if I stop attending classes OR no later than the return date as follows: Spring Semester = May 6, 2024I understand that there will be a fee of $100 if the equipment is lost or stolen.What is the best way to contact you? *TextCallEmailPhone: *Email:Do you have a smartphone or tablet with data or internet? *YesNoDo you have a computer or laptop at home? *YesNoDo you have reliable internet at home? *YesNoWhat will you use the laptop for? How will the laptop help you in your class or tutor program? *If you are approved for a laptop loan, can you pick up the laptop at our office? Staff are at the office from 8:30am-8pm Monday-Thursday. *YesNoLaptop Pickup Instructions A staff will call you to let you know if your laptop loan request is approved. If approved, the staff will schedule a time for you to pick up the laptop. Address: 701 Dane St. Madison, WI 53713 Office hours: Mondays – Thursdays 8:30am – 8pm Literacy Network is on the corner of South Park St. and Dane St., next to Walgreens and across from Goodman Library. Schedule an Appointment for Laptop Delivery If your laptop loan request is approved, a Literacy Network staff will arrange to deliver the laptop. What address should we deliver it to? *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSubmit
