This form is used to request the use of up to 15 GPS units for classroom use.   Complete this form and email your request to T. Johnnie You may contact her by calling (719) 598-2732 or (719) 337-1552.

Requester (Print full name):  _______________________________________      
School Name: __________________________________________________
School Address: ________________________________________________
School Phone Number: ___________________________________________
Home Address: _________________________________________________
Home Phone Number:   __________   Cell Phone Number: _______________
Number of Garmin Etrex Personal Navigator (GPS) units with cases:   
      Checked Out________  Returned  _____________
Condition of Garmin Etrex Personal Navigator (GPS) units:                  
      Checked Out  ______               Returned  _____________
Number of Garmin Etrex (GPS) units Owner's Manuals requested:        
      Checked Out________ Returned  _____________
Number of Compasses Requested:                                                       
      Checked Out________  Returned  _____________

Please note:  These GPS units each require two AA batteries which are not included.  To install the batteries, remove the battery cover by turning the D-ring on the back of the unit 1/4 turn counter-clockwise.  Insert the batteries observing proper polarity.  Attach the battery cover by turning the D-ring 1/4 turn clockwise (See Owner's Manual, pg. 8)  Remove your batteries before returning the GPS units to us.

Additional Information or comments

Planned Use:
Total number of students who will be trained on the use of this equipment
Grade level(s) of students who will be trained on the use of this equipment
Date Requested:           
 
Date Out:                       __________________  (complete at pickup)

Date to be Returned:    __________________
 
Date Actually Returned:  __________________  (complete upon return)

I understand and agree that by signing this form, I certify that I intend to use the property and/or materials described above for classroom purposes as described above.  I understand I am personally responsible for the above and will replace it if is lost, stolen or damaged.  I will return the equipment on time to the appropriate hub coordinator.
Borrower's Signature:____________________________________________ (complete at pickup)
Date Signed:______________________________________ (complete at pickup)
Return Instructions:
Please return to:  Tammy Johnnie as per arrangement with her.

Phone: ___________________  Cell: ____________________
E-mail:_____________________________