University of Wisconsin-Stout—Acceptance of Equipment Transfers
Procedures for Accepting Equipment Transfers and Instructions for Use of this Form
Equipment transfers are defined as equipment, supplies, or property offered without significant restrictions as to
use or requirements for reporting, use, or disposition. Equipment transfers are governed by UW-System and UW-Stout
policy and procedures.
This form must be completed and approved prior to the equipment transfer. This form may be initiated by any
member of UW-Stout faculty or staff involved in the transfer. Costs associated with the equipment transfer must be fully
addressed before transfer. All costs are the responsibility of the accepting department/unit. Forward the completed
form to Research Services, 152 Vocational Rehabilitation Building. If you have questions, please call Research
Services at 232-1126. Research Services will forward copies to the Negotiator, Department Chairperson, Dean, Vice
Chancellor for Administrative and Student Life Services, Inventory Coordinator, and Risk Management area.
Description of equipment or item(s) being transferred: Click here to enter text.
Benefits of transfer to university: Click here to enter text.
Transferred from:
Agency
Click here to enter text.
Name:
Street Address Click here to enter text.
City Click here to enter text.
State Click here to enter text.
ZIPClick here to
enter text.
Contact
Person:
Click here to enter text.
Email: Click here to enter text.
Phone: Click here to enter text.
Date of offer: Click here to enter text.
Target shipping date: Click here to enter text.
☐Yes ☐No Were any restrictions as to use, disposition, or reporting requirements stipulated as a condition of
the transfer? If “Yes,” explain:Click here to enter text.
☐Yes ☐No Is there a contract with this transfer? If “Yes,” do NOT sign—attach the contract to this form.
☐Yes ☐No Are there any special conditions concerning the transfer? If “Yes,” provide detail: Click here to enter
text.
☐Yes ☐No Does this involve a purchase discount? If “Yes,” call the Director of Purchasing.
Estimated Market Value: Click here to enter text.
Negotiator’s
Name:
Age of equipment in years: Click here to enter text.
Signature:
Date:
Click here to enter text.
Department: Click here to enter text.
College/Unit: Click here to enter text.
Division: Click here to enter text.
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University of Wisconsin-Stout—Acceptance of Equipment Transfers
Identify potential costs associated with the transfer. (All costs are the responsibility of the accepting
department/unit.)
☐Shipping/Transport Costs $ Click here to enter text.
☐Physical Plant Costs (i.e.: hook-up, service) $ Click here to enter text.
☐Remodeling Costs $ Click here to enter text.
☐Training Costs $ Click here to enter text.
☐Space Requirements/Storage—Attach Plan & Cost $ Click here to enter text.
☐Maintenance/Operating—Attach Plan & Cost $ Click here to enter text.
☐Other Cost $ Click here to enter text.
Attach certificate of insurance. Provide any further information: Click here to enter text.
Signature:
Date:
Signature:
Date:
Signature:
Date:
Provost and Vice
Chancellor for Academic
and Student Affairs:
Signature:
Date:
Vice Chancellor for
Administrative and
Student Life Services:
Signature:
Date:
Department/Unit Chair:
Dean/Director:
Research Administrator:
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