Personal Computer Loan Application

*All fields are required  Name:   Empl. ID:   Extension:   Home Address:   Email Address:   City:   State:   Zip Code:

Department:  Term of Loan (up to 2 years):  Applicant Signature:                                                                                        Date:                          I hereby verify that the above named individual is a full-time employee of my department, with at least six(6) months of continuous full-time service with the university and is not presently involved in any progressive discipline (including verbal warning, written warning, final written warning, performance improvment plan) or received a performance rating of "Needs Improvement".   Supervisor/Dean Name:  Supervisor/Dean Signature:                                                                                        Date:

Office use only Loan Approved:                                                Loan Amount:                                                Loan Denied:                                                Term of Loan:                                                Initials:                                                Installment Amount: