Asset Management Forms	ASSET MANAGEMENT TEL NO: (818) 677-2311 FAX NO: (818) 677-6702 MAIL DROP: 8209
	Off-Campus Home User Permit

Employee:

Department:

Ext:

Home Address:

City:

State/Zip:

Phone:

The Employee is responsible for the care and security of listed equipment removed from this campus.

Tag #	Serial #	Description	Date Removed	Date Returned

1.	Should the employee terminate employment from the University (or move to a different University department), the employee must return the equipment to the department that authorized home use.
2.	Asset Management may request that the authorizing department re-certify the existence and use of the equipment in connection with its annual survey of University equipment.

Signature of Employee: _________________________________	Date: ____________
Signature of Dean/Director/VP:___________________________	Date: ____________
Authorized Signature (Dept. Head): _______________________	Date: ____________
Please provide copies for the Employee, Department Head, Dean, and Asset Management, Mail Drop 8209.