Center for the Study of Social Dynamics
Equipment Checkout Form
Complete and return to Pamela Hunt, Director,
Phone: 678-839-6336, fax: 678-839-6506, email phunt@westga.edu
DATE: ___________________
PRINCIPAL INVESTIGATOR
Name:
Phone:
Email:
______________________________________________________________________________
EQUIPMENT REQUESTED:
_____________________________________________________________________________
EXPECTED DATES and TIME OF EQUIPMENT USE:
______________________________________________________________________________
______________________________________________________________________________
PROJECT DESCRIPTION (In a paragraph or two, describe your objectives, activities and
anticipated results. You may instead attach an abstract of a previously prepared proposal or work
plan):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
I, _________________________________ agree to return the above-described equipment in the
same condition as was given by ______, ___________________, 2012.
APPROVED ON ________, ___________________, 2012 BY:
______________________________________Lab Manager/Director (Circle One)