GLOBAL HEALTH CENTER

SUPPLIES & RESOURCES RESERVATION

 
If you have any questions, please contact Tina Lengle at 531-0003 ext. 285333 or tlengle@hmc.psu.edu.
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1. First and Last Name
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2. Email Address
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3. Phone Number
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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:
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Expected Return:
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7. Comments: Indicate the intended purpose of the item(s).
8. How long would you like to reserve this item/these items?
MM DD YYYY
Check-out:
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Expected Return:
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9. Comments: Indicate the intended purpose of the item(s).
10. OFFICE SUPPLIES: Please indicate which items you wish to reserve. The number in parenthesis indicates the quantity available.
11. How long would you like to reserve this item/these items?
MM DD YYYY
Check-out:
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Expected Return:
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12. Comments: Indicate the intended purpose of the item(s).
13. LITERATURE: Please indicate which items you wish to reserve. The number in parenthesis indicates the quantity available.
14. How long would you like to reserve this item/these items?
MM DD YYYY
Check-out:
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Expected Return:
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15. Comments: Indicate the intended purpose of the item(s).
16. DVDs: Please indicate which items you wish to reserve. The number in parenthesis indicates the quanity available.
17. How long would you like to reserve this item/these items?
MM DD YYYY
Check-out:
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Expected Return:
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18. Comments: Indicate the intended purpose of the item(s).
19. CD-ROMs: Please indicate which items you wish to reserve. The number in parenthesis indicates the quantity available.
20. How long would you like to reserve this item/these items?
MM DD YYYY
Check-out:
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Expected Return:
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21. Comments: Indicate the intended purpose of the item(s).