Name
Date/Time

Student iPad Assignment -  Loan Agreement                

This agreement is between the Department of Medical Education at The Icahn School of Medicine at Mount Sinai, and students who are agreeing to borrow equipment and/or software from the Department of Medical Education. The student is being issued an iPad Mini device with charging accessories, for use with Epic Canto and Zoom. Students who are approved by the Department of Medical Education staff to borrow equipment and/or software are subject to the following conditions:

Student Responsibilities:

A. It is the student’s responsibility to care for the equipment and ensure it is kept in a safe environment. The student must maintain the equipment in the same condition in which it was received.

      1. In the event of any issues with the equipment, the student must immediately return it to the Department of Medical Education for repair.

      2. Any repair costs caused by improper use will be the responsibility of the student.

      3. The equipment will remain in student’s possession and will not be loaned to others.

      4. Student will not remove or alter any part or accessory of the equipment.

      5. Student will not attempt to make any repairs to the equipment.

B. The student must be prepared to return the equipment upon request (by End of the Academic Year).

      1. The student is required to delete all information in the device and restore to its factory default settings upon return. (Settings>General>Reset>Erase All Content and Settings)

      2. Students will not be permitted to retain equipment for periods outside of the academic year.

      3. Equipment must always be returned by the end of each academic year.

C. The student is also financially responsible for any theft or damages of the loaned equipment.

D. In the event of any default on this agreement a "hold" will be placed on all student records, transcripts and further enrollment until such time as the equipment is returned in good working condition or until full financial restitution is made.

E. The student agrees to use the equipment only for its specific intended purpose.

      1. The iPad Mini device is being assigned specifically for using Epic Canto and Zoom in clinical situations.

      2. Student agrees not to install or utilize any software in connection with use of the device other than Epic Canto or Zoom, in accordance with this receipt and agreement, and agrees not to make any unauthorized use of or modifications to such software.

      3. Student agrees not to put any personal information into the device other than Epic and/or Zoom credentials, and Apple ID information.

Checkbox
Use your mouse or finger to draw your signature above