GLOBAL HEALTH CENTER

SUPPLIES & RESOURCES RESERVATION

 
If you have any questions, please contact Thao Danz at 531-3877 or tdanz@psu.edu.
*
1. First and Last Name
*
2. Email Address
*
3. Phone Number
*
4. Your role/position at the medical school (e.g. 1st year medical student, 4th year nursing student, assistant professor, etc)
5. MEDICAL SUPPLIES: Please indicate which items you wish to reserve. The number in parenthesis indicates the quantity available.
6. How long would you like to reserve this item/these items?
MM DD YYYY
Check-out:
/
/
Expected Return:
/
/
7. Comments: Indicate the intended purpose of the item(s).
8. TECHNOLOGY EQUIPMENT: Please indicate which items you wish to reserve. The number in parenthesis indicates the quantity available.
9. How long would you like to reserve this item/these items?
MM DD YYYY
Check-out:
/
/
Expected Return:
/
/
10. Comments: Indicate the intended purpose of the item(s).
11. OFFICE SUPPLIES: Please indicate which items you wish to reserve. The number in parenthesis indicates the quantity available.
12. How long would you like to reserve this item/these items?
MM DD YYYY
Check-out:
/
/
Expected Return:
/
/
13. Comments: Indicate the intended purpose of the item(s).
14. LITERATURE: Please indicate which items you wish to reserve. The number in parenthesis indicates the quantity available.
15. How long would you like to reserve this item/these items?
MM DD YYYY
Check-out:
/
/
Expected Return:
/
/
16. Comments: Indicate the intended purpose of the item(s).
17. DVDs: Please indicate which items you wish to reserve. The number in parenthesis indicates the quantity available.
18. How long would you like to reserve this item/these items?
MM DD YYYY
Check-out:
/
/
Expected Return:
/
/
19. Comments: Indicate the intended purpose of the item(s).
20. CD-ROMs: Please indicate which items you wish to reserve. The number in parenthesis indicates the quantity available.
21. How long would you like to reserve this item/these items?
MM DD YYYY
Check-out:
/
/
Expected Return:
/
/
22. Comments: Indicate the intended purpose of the item(s).