RICHARD BLAND COLLEGE

FACULTY/STAFF REQUEST FOR TEMPORARY USE OFF-CAMPUS OF STATE PROPERTY

NAME________________________________________________

DATE SUBMITTED____________________________________

TO: __________________________________________________________

Dean of Administration and Finance or Human Resource Director

SUBJECT: Request For Temporary Use Off-Campus of State Property

I request temporary use off-campus of the following state owned item(s):

1. ___________________________________________________________________

2. ___________________________________________________________________

3. ___________________________________________________________________

4. __________________________________________________________________

The above item(s) belonging to Richard Bland College is being borrowed and taken off campus on _______________________, 2____. Date item(s) to be returned to Richard Bland College _______________________, 2____. I understand and agree that the item(s) being borrowed from Richard Bland College is to be returned in the same condition as it was when borrowed. If the item(s) is returned damaged, the employee will be responsible for repairing/replacing the above stated item(s). If the item(s) borrowed is lost and is not returned, the employee will be responsible for replacing the item(s) with another of the same value or reimbursing Richard Bland College.

__________________________________________________________________________________ Signature of Employee Borrowing State Property

__________________________________________________________________________________ Approved by: Dean of Administration and Finance or Human Resource Director

The above item(s) was returned to Richard Bland College on ____________________, 2____ and is in the same condition as it was when borrowed by the College.

______________________________________________________________________

Approved by: Dean of Administration and Finance or Human Resource Director