The Evergreen State College

Institutional Account Application and Update Form

Apply for an Institutional Account to have equipment checked out for your program or office/insitutional unit. Questions or concerns? Please contact Lin Crowley at 867-6239 or via email.

* Required fields

Program / Institutional Office *	Primary Faculty / Staff *	Phone *	Account# *
A value is required.	A value is required.	A value is required. A value is required.	A value is required.
Email*
A value is required.Invalid format.

The following individuals may check out equipment on this Institutional Account
Name	Banner ID / A#	Name	Banner ID / A#

Comments:

Please make a selection.

By checking this box and submitting this form,

I agree to track the equipment check-out/return receipts for this institutional account. I understand my institutional account may be charged for late returns or damages of equipment that are checked out to our institutional account.

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