Historically American.  Uniquely Caribbean.  Globally Interactive. 
 
Emerging Caribbean Scientists Programs 
#2 John Brewer’s Bay ● St. Thomas, U. S. Virgin Islands 00802 ● Tel: (340) 693-1249 ● Fax: (340) 693-1245 ● Email: ecs@uvi.edu  
 
EQUIPMENT LOAN FORM 
*Please print clearly. 
BORROWER: 
(Print Name) 
Phone:  
Email: 
DEPARTMENT: 
PURPOSE: 
LOAN DATE: 
(mm/dd/yyyy) 
 
ITEM(s)  
DESCRIPTION 
COUNT 
Withdrawn 
CAMPUS COUNT 
Returned 
 
 
 
 
 
 
 
 
Use the back of this sheet if more space is needed. 
 
RETURN DATE: 
(mm/dd/yyyy) 
BORROWER: 
(Signature) 
 
The borrower understands that he/she is responsible for the 
items listed above and agrees to return all items in the same 
condition in which they were withdrawn.  
Damages may incur a cost. 
 
Approved by: 
(Print Name) 
 
(Sign and Date) 
 
 
To be completed when items are returned. 
 
RECEIVED BY: 
 
 
 
 
 
 
 
DATE: 
 
 
NOTES: