Student Affairs Technology Lending Request Form

The application process for the Student Affairs Technology Lending Program is open during Summer Session 2 through Fall Quarter (July 18 - October 17, 2022).

First Name *
Last Name *
PID *
Email (Please only use your UCSD email account) *

You must use your UCSD email account, @ucsd.edu
Please select your location. *

Please select your location. On Campus Off Campus
If you are staying off campus, what is the address?
Do you have a mobile phone? *

Do you have a mobile phone? Yes No
If you have a mobile phone what carrier do you use?
Do you have a tablet (iPad, etc.)? *

Do you have a tablet (iPad, etc.)? Yes No
If you have a tablet, list the internet options below.

If you have a tablet, list the internet options below. Wi-fi only Wi-fi plus cellular
Do you have internet access where you are staying for Winter Quarter? *

Do you have internet access where you are staying for Winter Quarter? Yes No
If you will have internet access, provide the connection speed if you know it.
Please indicate what other computer you may have access to after Spring Quarter
Time Time : HH MM AM/PM
Time Time : HH MM AM/PM
Date Date / MM / DD YYYY
Date Date / MM / DD YYYY
Email
Email