Adaptive Technology Center for New Jersey Colleges
at The College of New Jersey
Department of Special Education
P. O. Box 7718 
Ewing, NJ 08628 
Phone:  (609)771-2610
Fax:      (609)637-5172
1999 - 2000 Academic Year

The undersigned, an authorized representative of ________________,  hereby agrees that all hardware, oftware, assistive devices, low-tech materials, and other items borrowed from the Adaptive Technology Center for New Jersey Colleges will:

  1. be requested and used by the institution for the sole purpose of enabling eligible students with visual, hearing, and/or learning disabilities to meet the academic demands of the institution;
  2. be borrowed for a term of one semester;
  3. be used with reasonable care, with precautions against damage and in a secure location;
  4. be used only for educational or education-related purposes;
  5. not be lent to ineligible students, sold or otherwise disposed of.
  6. be returned to the center prior to the expiration of the loan period if the equipment is not in use.

I further agree that:

  1. pick-up and delivery of heavy, large and fragile items will be the responsibility of the borrowing institution;
  2. training will be requested from the center if needed;
  3. all repair and/or replacement costs will be the responsibility of the borrowing institution;
  4. the center will be notified immediately of any loss or damage to the equipment;
  5. this signed agreement is in effect for one school year and will be returned before the first loan is made.
I assure the Adaptive Technology Center that:
  1. the student has presented written evidence of his/her disability;
  2. the student is registered for one or more classes by this New Jersey college or university;
  3. or is registered in an extension course offered off campus by this New Jersey college or university.

  4. Signed:__________________________________________________  Date:________________
                             Director, Disability Support Services Office

    Print Name and Title: ____________________________________________________________

    Funded by the Special Needs Grant Program of the New Jersey Commission on Higher Education