Technology Materials Requests

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

All check out items available below are provided through the SI Program. If you need a Hotspot for internet or Laptop, please use the MiraCosta Student Technology Request Form.

What is your full name? *

What technology would you like to checkout? Please select all that apply: *

XP Pen Tablet for handwriting

Headset with microphone

Webcam

PC Tablet computer (like a Surface)

None

Required

Please list a few dates and times when you can go to the Oceanside campus SI Office in T118 to check out and pick up the requested technology. Generally, the office is staffed Mon-Thurs 8:30am-4:30pm. Additional days and times can be provided. If you don't need any tech, please leave blank.

Checkout Agreement:

Check the boxes below to indicate that:

You agree that all technology checked out is property of the District and you will not alter, interfere with, or modify any original components such as taking apart, affixing stickers, etc.

You agree to keep the technology clean, in good repair, and in working order. If any technology malfunctions, inform the SI Program immediately and we will provide a replacement if available.

Upon your resignation or the request of the District, you agree to return the original box and all contents to the SI Program.

I am not requesting to borrow any tech.

Any questions, comments, or concerns?

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms