CLARKCOUNTYSCHOOLDISTRICT

STUDENTSERVICESDIVISION
ASSISTIVETECHNOLOGYSERVICESDEPARTMENT
AGREEMENTFORLOANOFASSISTIVETECHNOLOGYEQUIPMENT

Pleasesignandreturnthisformsothe___________________canbegintogohome.
Understandthatthispieceofequipmentmusttravelbackandforthtoschoolandisnotfor
homeuseonly.

TheClarkCountySchoolDistrict(CCSD)reservestherighttorefrainfromsendingthe
equipmenthomeifitisrepeatedlyreturnsuncharged,innonworkingcondition,orrepeatedly
failstocomebacktoschool.

Student:___________________________ School:____________________ Grade______

Parent:_____________________________________________________________________
Address:____________________________________________Phone:__________________
EquipmentLoaned:___________________________________________________________
Model:__________________ Serial#____________________________ AST#________
DateIssued:_____________________________ ReturnDate:_______________________
EquipmentIssuedBy:_____________________________ Title:___________________
IagreetoreturntheaboveequipmentingoodworkingordertoCCSD,StudentServicesDivisionatthe
endoftheloanperiod.If,foranyreason,returnoftheequipmentisnotpossible,Iwillreplaceitwith
identicalequipmentorreimbursetheCCSDatthecurrentreplacementcost.Presentreplacementcost
forthisinstrumentis$____________.Thispriceissubjecttochange.Thisagreementismadein
accordancewithNRS393.170andClarkCountySchoolDistrictPolicyandRegulation5134which
governsotherCCSDownedpropertysuchaslibrarybooks,textbooks,supplies,andequipment.

Iftheequipmentisnotreturnedingoodworkingorder,IunderstandthatIwillberesponsibleforthe
costsofrepairandthatreplacementequipmentmaynotbeprovidedwithoutamonetarydeposit.

Ifthisloanformpertainstoanaugmentativecommunicationdevice,youwillbeabletochangeand
programthedevicefollowingtrainingatAssistiveTechnologyServiceson_______________.Weask
thatyourefrainfromchanginganyofthesettingsonthedeviceuntilyouhavebeentotraining.

Also,pleasenotethatyouareresponsibleforchargingthedeviceeacheveningandsendingthecharger
backandforthtoschooldailysothedevicewillbereadytouse.

____________________________________________ __________________
Parent/GuardianSignature Date
____________________________________________ __________________
StudentSignature* Date

*StudentsofMiddleSchoolLevelandaboveshouldcosignthisform

Pleasereturnasignedcopyofthisagreementto:AssistiveTechnologyServices(Location#197)orFaxto8558448
CLARKCOUNTYSCHOOLDISTRICTREGULATION5134

CAREOFSCHOOLPROPERTY
I. ResponsibilityforMaterial:Studentsandtheirparentsorguardiansshallberesponsiblefor
alldamagetoorlossoftextbooks,librarybooks,orothermaterials,equipment,orschool
propertyloanedtoorusedbythestudentandshallreimbursetheClarkCountySchool
Districtforsuchlossordamage.
II. DamageAssessment
A. Theprincipalorwhoeverisdelegatedshallberesponsibleforcollectingthefullpurchase
priceofanysuchitemthatislost,destroyed,orsodamagedastomaketheitemunfitfor
futureuse.
B. Theprincipalmaydisciplinestudentsfordamageorlossoftextbooks,withholdtherightto
participateinstudentactivities,andrequireamonetarydepositforreplacementtextbooks
fromstudentswhohavepreviouslylostordamagedtextbooksormaterials.
C. Informationaboutpricescanbeobtainedfromthefollowingthreesources:
1. Textbooks:TextbookProceduresManual/Catalogortextbookcontrolclerk.
2. LibraryBooks:LibraryServicesOffice,CurriculumandProfessionalDevelopment.
3. SuppliesandEquipment:PurchasingandWarehousingDepartment.
III. Accounting:MoneycollectedasprescribedaboveistobeturnedintotheAccounting
Department

NRS393.170Librarybooks,textbooksandotherschoolsupplies:Purchase;paymentfordamage;
ownership;penalty.
1.Theboardoftrusteesofaschooldistrictshallpurchaseallnewlibrarybooksandsupplies,allnew
textbooksandsupplementaryschoolbookswhicharenecessaryandhavebeenapprovedbytheState
BoardofEducation,andschoolsuppliesnecessarytocarryoutthemandatesoftheschoolcurriculumto
beusedbythepupilsoftheschooldistrict.Thecostofthebooksandsuppliesisalegalchargeagainst
theschooldistrictfund.
2.Allbookspurchasedbytheboardoftrusteesmustbeheldaspropertyoftheschooldistrict,and
mustbeloanedtothepupilsoftheschoolintheschooldistrictwhilepursuingacourseofstudytherein.
3.Theparentsandguardiansofpupilsareresponsibleforallbooksandanyandallothermaterialor
equipmentloanedtothechildrenintheircharge,andshallpaytotheclerkoftheboardoftrustees,or
toanyotherpersonauthorizedbytheboardtoreceivethesame,thefullpurchasepriceofallsuch
books,materialorequipmentdestroyed,lostorsodamagedastomakethemunfitforusebyother
pupilssucceedingtotheirclasses.Theboardoftrusteesshallestablishreasonablerulesandregulations
governingthecareandcustodyofsuchschoolpropertyandforthepaymentoffinesfordamage
thereto.
4.Equipmentandmaterialsforuseinmanualtraining,industrialtrainingandteachingdomestic
sciencemaybesuppliedtothepupilsinthesamemanner,outofthesamefund,andonthesameterms
andconditionsasbooks.Noprivateownershipmaybeacquiredinsuchequipmentormaterial,unless
soldinthemannerprescribedbylawwhensuchequipmentormaterialarenolongerusedorrequired
fortheschoolsoftheschooldistrict.
5.Authorizedsupplementarybooksanddeskbooksfortheuseofteachersmustbepurchasedunder
NRS393.160to393.210,inclusive,andremainthepropertyoftheschooldistrictforwhichtheywere
purchased,unlesssoldinaccordancewiththeprovisionsofthischapter.
6.Theclerkoftheboardoftrusteesshallturnovertothecountytreasurer,within30daysafter
receivingit,allmoney,collectedundertheprovisionsofthissection,andthemoneymustbecreditedto
theschooldistrictfund.
7.Anypersonviolatinganyoftheprovisionsofthissectionisguiltyofamisdemeanor.
[425:32:1956](NRSA1967,567;1973,235;1991,478)