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: