Equipment Checkout Form Equipment Checkout Form First Name* Last Name* I received the following equipment from the University of Washington Math Science Upward Bound (UW STEMsub) Program for academic use:* Laptop Graphing Calculator OtherOther Make/Model: * Serial Number:* UW Tag Number:* I am responsible for its safe use and return to the Math Science Upward Bound Program on or before the last day of the current academic school year. If equipment is not returned in good working order by this date, I may be charged for replacement cost. Print Student Name* Student Signature* signature keyboard Clear Date* Print Parent Name* Parent Signature signature keyboard Clear Date* Submit Δ