Biotechnology Equipment Loan Program
EQUIPMENT MUST BE RETURNED NO LATER THAN 4 WEEKS AFTER BORROWING!
Date
Borrowed
Borrower
Initials
PBSC Staff
Initial
Date
Returned
DUE DATE
(Edison: enter date that
is 4 weeks from today)
Borrower
Initials
PBSC Staff Initial
inspect equipment
before signing
To be populated by borrower: Please describe the intended use of the borrowed item(s):
Item Information
Quantity
Borrowed
Item Name
Name (print)
Title
Item Manufacturer
Item Serial
Number
Condition of item at
Checkout: New (1-3yrs),
Used (3-5yrs), Old (>6yrs)
Room #
of Item
Contact Information of Person Borrowing Equipment
Affiliation &
Phone
Email
Supervisor Name and
Address
Contact
By signing this form and borrowing PBSC’s equipment, you agree to provide PBSC:
1. Photos of students using the equipment.
2. Your students (and you) complete a short survey at the end of the loan term about your
experiences with the equipment (questions about what they did, what is biotechnology, career
goals, college planning).
3. A 1-page summary statement written by you about what you and the students worked on, the
experiments, hypotheses tested, and the results. What went wrong, what could be improved,
what are the next steps for the project, how were the techniques incorporated into your
existing curriculum.
_____________________
Borrower’s signature
____________________
PBSC staff signature