I understand and acknowledge the above terms and conditions associated with the Easterseals Arkansas Outreach Program and Technology Services (esOPTS) Short-Term Loan Program. In addition, I affirm I am authorized by the district to sign this agreement and accept district financial responsibility for lost or damaged items.
Date: Use the calendar button on the right to select the date (required)
Name of District Administrator Signing Loan Agreement (Full Name) (required)
Job Title
District (required)
Administrator Email (required)
Administrator Phone Number
Name of Employee Requesting Loan (Full Name) (required)
Email of Employee Requesting Loan (Full Name) (required)
Administrator Signature (required)Please use your cursor to sign your name, or if you are using a touchscreen use your finger or stylus pen
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