ATRC Loan Program Interest Form

To begin the process of borrowing an automated counter, please fill out this interest form. Someone from the ATRC will be in contact with you via a phone call within 3 days of receiving this form.

Please note: * (asterisk) Indicates a required field.

Agency Contact Information

First Name

Last Name

Potential Borrowing Loan Dates

Please identify the potential dates you wish to borrow/use the equipment. Depending on demand, the ATRC will do its best to get you the equipment you need at the time you need it.

Each loan period is expected to be one month in duration. This allows for one week to obtain the equipment and get it ready to install, one to two weeks to conduct the counts, and one week to take down the equipment and send it back.

Month/Day Begin

Month/Day End

Count Type

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The College of Continuing Education respects your right to privacy. Any information given to us when requesting course or program material will be used solely for the purpose of answering or responding to your request. We do not sell or otherwise distribute your personal information. We may, however, use it to provide you with advanced notices of our course offerings. If at any time you wish to be removed from our mailing lists, you may contact us and your request will be processed immediately.