APPLICATION FOR LEASING TI CALCULATORS
Please read and fill out this form completely. Return this form and money to your mathematics teacher
Please Print
Student Name_________________________________________________Grade
10 11 12
(Circle one)
Math Class______________________Period_________Teacher___________________
Student ID______________________
TI graphing calculators may be leased for the 02-03 school year. Calculators will be issued in working order and must be returned in working order. If a problem exists during the first five days, please return the calculator to your math teacher for replacement. After this period, if battery replacement is necessary, this will be the responsibility of the student. If a calculator is used one semester or less, one half of the leasing fee will be refunded. In case of loss or damage to a calculator, the student will be required to pay the balance for the loss. Scholarship students will be required to pay the leasing fee and the balance for loss, if calculator is lost or damaged. Calculators are due for return the day the student finishes the final exam for his/her math class. Manuals for the calculators are available upon request.
LEASING FEE BALANCE FOR LOSS
TI-83
$30.00
$50.00
TI-83+
$35.00
$55.00
I have read and I understand the conditions for leasing a calculator.
Student Signature__________________________________________
Parent Signature___________________________________________
Home Address_______________________________________Home Phone____________
If not complete, this form will be returned to you.
DO NOT WRITE BELOW THIS LINE
_____________________________________________________________________________________________
Date of Application________ Received by ___________
Calculator Number_______________ Date Out___________
FEE: Check or Cash $___________ Date In ____________
Check #_________
Early Refund:
Yes or No