Computer Loan Application
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  • (Please check all that apply.)
  • ACADEMIC INFORMATION

    Please attach a copy of your class schedule.
  • Must be PDF, DOC, DOCX, CSV, XLS, XLSX, TXT, RTF, or JPG.
  • REFERENCES

    Name, Phone Number, and Address of THREE References: ( i.e. Employer, Faculty, Family Member, and/or Friend)
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  • STUDENT CONFIRMATION

  • Please sign using your mouse, screen or touch-pad to confirm you understand the terms listed in this agreement. A second signature is required below.
  • RESPONSIBLE USE POLICY


    Students are responsible for maintaining the good condition of the notebook by:

    - Reporting any problems immediately to the Loan Program Help Desk.

    - Meet with the Loan Program Help Desk personnel (by appointment).

    - Returning the computer to the Loan Program Help Desk by the return date on
    the contract or on request by the Loan Program Help Desk.

    - Being responsible for damages by any cause (BHC limits student liability to
    $500 per occurrence).

    - Not installing software.

    - Students that withdraw from classes must surrender the computer immediately.

    Failure to comply with these terms may result in termination of this contract. Failure to return the laptop upon request or by the contract date will result in a Denial of Enrollment, which means a student cannot enroll in classes or obtain an official transcript. If the computer is not returned after the Denial of Enrollment is issued, the student may be assessed the current market value of the notebook computer,
    the Black Hawk College Police Department will be notified and an arrest warrant may be issued. Also, the student understands that he/she forfeits any future eligibility in the Student Laptop Loan Program if they fail to comply with the terms of the Responsible Use Policy.
  • Please sign using your mouse, screen or touch-pad to confirm you have read the "Responsible Use Policy"
  • The Perkins program is funded through the Strengthening Career and Technical Education for the 21st Century Act.

    Black Hawk College will make all educational and personal decisions without regard to race, color, religion, gender, sexual orientation, marital status, national origin or ancestry, age, physical or mental disability unrelated to ability, or status as a disabled veteran or Vietnam era veteran, except as specifically exempted by law.
    If you will need an accommodation based on disability (e.g. sign language interpreter, special seating) to fully participate in any Black Hawk College activity or program, please contact the Disability Services Office at 309-796-5900, CAPTEL at 309-796-5903 or video phone at 309-716-3310. Please allow sufficient time to make arrangements. No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination
    under any education program or activity receiving Federal financial assistance. Legal Citation: Title IX of the Education Amendments of 1972, and its
    implementing regulation at 34 C.F.R. Part 106 (Title IX).
  • WE RECOMMEND YOU PRINT THIS PAGE FOR YOUR RECORDS BEFORE YOU SIGN AND SUBMIT (right click and select “Print”)