Laptop Loan Application Question Title * 1. First Name Question Title * 2. Last Name Question Title * 3. Student ID Number Question Title * 4. Date of Birth Month Day Year Date January February March April May June July August September October November December Date Month menu 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Date Day menu 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 Date Year menu Question Title * 5. Phone Number Question Title * 6. COS Email Address Question Title * 7. Explanation of Need Please explain in 5 sentences or more why you are in need of a laptop? Also how will not having a laptop impact your ability to be successful in your online courses? Question Title * 8. By selecting the check box below, you acknowledge that you are assuming full responsibility for replacing the laptop should it be damaged while in your use. You will also be required to complete a laptop loaner student contract when picking up the laptop. I acknowledge the Terms of Use Done