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<P><BR></BR><BR></BR><BR></BR><BR></BR></P><FORM action="//web.mit.edu/bin/cgiemail/afs/athena.mit.edu/astaff/project/helpdesk/forms/llp-request.txt" method="post">
<TABLE border="0" cellpadding="2" cellspacing="2">
<TBODY><TR><TH align="right" valign="top">Your name:</TH><TD align="left" valign="top"><INPUT maxlength="200" name="client-full-name" size="40" type="text"></INPUT></TD></TR>
<TR><TH align="right" valign="top">Your MIT username:</TH><TD align="left" valign="top"><INPUT maxlength="8" name="client-username" size="40" type="text"></INPUT> <I>(a.k.a. Kerberos name, eight characters max)</I></TD></TR>
<TR><TH align="right" valign="top">Your MIT email address:</TH><TD align="left" valign="top"><INPUT maxlength="200" name="client-email" size="40" type="text"></INPUT> <I>(Important!)</I></TD></TR>
<TR><TH align="right" valign="top">Your MIT ID number:</TH><TD align="left" valign="top"><INPUT maxlength="9" name="client-mit-id" size="40" type="text"></INPUT> <I>(Nine digits)</I></TD></TR>
<TR><TH align="right" valign="top">Your Department:</TH><TD align="left" valign="top">
<SELECT name="client-department">
<OPTION value="UNKNOWN">Beats me...</OPTION>
<OPTION value="Academic Media Production Services-Libraries">Academic Media Production Services-Libraries</OPTION>
<OPTION value="Accounts Payable">Accounts Payable</OPTION>
<OPTION value="Administrative Services: Chemical Engineering & MS">Administrative Services: Chemical Engineering & MS</OPTION>
<OPTION value="Admissions Office">Admissions Office</OPTION>
<OPTION value="Air Force Aerospace Studies">Air Force Aerospace Studies</OPTION>
<OPTION value="Alumni Association">Alumni Association</OPTION>
<OPTION value="Anthropology Program">Anthropology Program</OPTION>
<OPTION value="Audio Visual Services">Audio Visual Services</OPTION>
<OPTION value="Audit Division">Audit Division</OPTION>
<OPTION value="Budget, Finance and Treasury">Budget, Finance and Treasury</OPTION>
<OPTION value="Cambridge-MIT Institute">Cambridge-MIT Institute</OPTION>
<OPTION value="Campus Activities Complex">Campus Activities Complex</OPTION>
<OPTION value="Campus Police">Campus Police</OPTION>
<OPTION value="Center for Advanced Visual Studies">Center for Advanced Visual Studies</OPTION>
<OPTION value="Center for Biomedical Engineering">Center for Biomedical Engineering</OPTION>
<OPTION value="Center for Biomedical Innovation">Center for Biomedical Innovation</OPTION>
<OPTION value="Center for Collective Intelligence">Center for Collective Intelligence</OPTION>
<OPTION value="Center for Educational Computing Initiatives">Center for Educational Computing Initiatives</OPTION>
<OPTION value="Center for Environmental Health Sciences">Center for Environmental Health Sciences</OPTION>
<OPTION value="Center for Global Change Science">Center for Global Change Science</OPTION>
<OPTION value="Center for Information Systems Research">Center for Information Systems Research</OPTION>
<OPTION value="Center for International Studies">Center for International Studies</OPTION>
<OPTION value="Center for Materials Science and Engineering">Center for Materials Science and Engineering</OPTION>
<OPTION value="Center for Real Estate">Center for Real Estate</OPTION>
<OPTION value="Center for Technology, Policy, & Industrial Develp">Center for Technology, Policy, & Industrial Develp</OPTION>
<OPTION value="Center for Transportation and Logistics">Center for Transportation and Logistics</OPTION>
<OPTION value="Chairman of the Corporation">Chairman of the Corporation</OPTION>
<OPTION value="Chancellor's Office">Chancellor's Office</OPTION>
<OPTION value="Clinical Research Center">Clinical Research Center</OPTION>
<OPTION value="Community Development & Substance Abuse Programs">Community Development & Substance Abuse Programs</OPTION>
<OPTION value="Comparative Media Studies">Comparative Media Studies</OPTION>
<OPTION value="Computer Science & Artificial Intelligence Lab">Computer Science & Artificial Intelligence Lab</OPTION>
<OPTION value="Concourse">Concourse</OPTION>
<OPTION value="Consortium on Financing Higher Education">Consortium on Financing Higher Education</OPTION>
<OPTION value="Controller and Accounting Services">Controller and Accounting Services</OPTION>
<OPTION value="Copy Technology Centers">Copy Technology Centers</OPTION>
<OPTION value="Corporate Relations/Industrial Liaison Program">Corporate Relations/Industrial Liaison Program</OPTION>
<OPTION value="Credit Union">Credit Union</OPTION>
<OPTION value="DAPER Administration">DAPER Administration</OPTION>
<OPTION value="DAPER Facilities">DAPER Facilities</OPTION>
<OPTION value="DAPER Intercollegiate Sports">DAPER Intercollegiate Sports</OPTION>
<OPTION value="DAPER Physical Education">DAPER Physical Education</OPTION>
<OPTION value="DAPER Recreation">DAPER Recreation</OPTION>
<OPTION value="DLC Heads Science">DLC Heads Science</OPTION>
<OPTION value="DUE Desktop Support">DUE Desktop Support</OPTION>
<OPTION value="David H Koch Institute for Integrative Cancer Res">David H Koch Institute for Integrative Cancer Res</OPTION>
<OPTION value="Department of Aeronautics and Astronautics">Department of Aeronautics and Astronautics</OPTION>
<OPTION value="Department of Architecture">Department of Architecture</OPTION>
<OPTION value="Department of Biological Engineering">Department of Biological Engineering</OPTION>
<OPTION value="Department of Biology">Department of Biology</OPTION>
<OPTION value="Department of Brain and Cognitive Sciences">Department of Brain and Cognitive Sciences</OPTION>
<OPTION value="Department of Chemical Engineering">Department of Chemical Engineering</OPTION>
<OPTION value="Department of Chemistry">Department of Chemistry</OPTION>
<OPTION value="Department of Civil and Environmental Engineering">Department of Civil and Environmental Engineering</OPTION>
<OPTION value="Department of Economics">Department of Economics</OPTION>
<OPTION value="Department of Facilities">Department of Facilities</OPTION>
<OPTION value="Department of Housing">Department of Housing</OPTION>
<OPTION value="Department of Linguistics and Philosophy">Department of Linguistics and Philosophy</OPTION>
<OPTION value="Department of Materials Science and Engineering">Department of Materials Science and Engineering</OPTION>
<OPTION value="Department of Mathematics">Department of Mathematics</OPTION>
<OPTION value="Department of Mechanical Engineering">Department of Mechanical Engineering</OPTION>
<OPTION value="Department of Nuclear Science and Engineering">Department of Nuclear Science and Engineering</OPTION>
<OPTION value="Department of Physics">Department of Physics</OPTION>
<OPTION value="Department of Political Science">Department of Political Science</OPTION>
<OPTION value="Department of Urban Studies and Planning">Department of Urban Studies and Planning</OPTION>
<OPTION value="Dept of Earth, Atmospheric, & Planetary Sciences">Dept of Earth, Atmospheric, & Planetary Sciences</OPTION>
<OPTION value="Dept of Electrical Engineering & Computer Science">Dept of Electrical Engineering & Computer Science</OPTION>
<OPTION value="Deshpande Center for Technological Innovations">Deshpande Center for Technological Innovations</OPTION>
<OPTION value="Design Laboratory">Design Laboratory</OPTION>
<OPTION value="Dining">Dining</OPTION>
<OPTION value="Division of Comparative Medicine">Division of Comparative Medicine</OPTION>
<OPTION value="Document Services">Document Services</OPTION>
<OPTION value="EHS Headquarters Office">EHS Headquarters Office</OPTION>
<OPTION value="Earth System Initiative">Earth System Initiative</OPTION>
<OPTION value="Edgerton Center">Edgerton Center</OPTION>
<OPTION value="Educational Council">Educational Council</OPTION>
<OPTION value="Endicott House">Endicott House</OPTION>
<OPTION value="Engineering Systems Division">Engineering Systems Division</OPTION>
<OPTION value="Experimental Study Group">Experimental Study Group</OPTION>
<OPTION value="Foreign Languages and Literatures Section">Foreign Languages and Literatures Section</OPTION>
<OPTION value="Forum for Higher Education">Forum for Higher Education</OPTION>
<OPTION value="Francis Bitter Magnet Laboratory">Francis Bitter Magnet Laboratory</OPTION>
<OPTION value="Fraternities, Sororities and ILGs">Fraternities, Sororities and ILGs</OPTION>
<OPTION value="GL Operations & Reporting & Journal Vouchers">GL Operations & Reporting & Journal Vouchers</OPTION>
<OPTION value="Global Education and Career Development Center">Global Education and Career Development Center</OPTION>
<OPTION value="Gordon Engineering Leadership Program">Gordon Engineering Leadership Program</OPTION>
<OPTION value="Gray House">Gray House</OPTION>
<OPTION value="HR/Payroll">HR/Payroll</OPTION>
<OPTION value="Harvd-MIT Division of Health Sciences & Technology">Harvd-MIT Division of Health Sciences & Technology</OPTION>
<OPTION value="Haystack Observatory">Haystack Observatory</OPTION>
<OPTION value="History Section">History Section</OPTION>
<OPTION value="Hobby Shop">Hobby Shop</OPTION>
<OPTION value="Human Resources Department">Human Resources Department</OPTION>
<OPTION value="Industrial Performance Center">Industrial Performance Center</OPTION>
<OPTION value="Information Services & Technology">Information Services & Technology</OPTION>
<OPTION value="Institute for Soldier Nanotechnologies">Institute for Soldier Nanotechnologies</OPTION>
<OPTION value="International Innovation Initiative">International Innovation Initiative</OPTION>
<OPTION value="Kavli Institute for Astrophysics & Space Research">Kavli Institute for Astrophysics & Space Research</OPTION>
<OPTION value="Kuwait - MIT Center for Natural Resource">Kuwait - MIT Center for Natural Resource</OPTION>
<OPTION value="Lab for Electromagnetic & Electronic Systems">Lab for Electromagnetic & Electronic Systems</OPTION>
<OPTION value="Laboratory for Information and Decision Systems">Laboratory for Information and Decision Systems</OPTION>
<OPTION value="Laboratory for Manufacturing and Productivity">Laboratory for Manufacturing and Productivity</OPTION>
<OPTION value="Laboratory for Nuclear Science">Laboratory for Nuclear Science</OPTION>
<OPTION value="Leaders for Global Operations Program">Leaders for Global Operations Program</OPTION>
<OPTION value="Legatum Center for Dev Entrepreneurship">Legatum Center for Dev Entrepreneurship</OPTION>
<OPTION value="Lemelson/MIT Program">Lemelson/MIT Program</OPTION>
<OPTION value="Libraries">Libraries</OPTION>
<OPTION value="Lincoln Laboratory">Lincoln Laboratory</OPTION>
<OPTION value="List Visual Arts Center">List Visual Arts Center</OPTION>
<OPTION value="Literature Section">Literature Section</OPTION>
<OPTION value="MIT Card Office">MIT Card Office</OPTION>
<OPTION value="MIT Energy Initiative">MIT Energy Initiative</OPTION>
<OPTION value="MIT Investment Management Company">MIT Investment Management Company</OPTION>
<OPTION value="MIT Press">MIT Press</OPTION>
<OPTION value="MIT Professional Education">MIT Professional Education</OPTION>
<OPTION value="MIT-Broad Affiliation">MIT-Broad Affiliation</OPTION>
<OPTION value="MIT-Portugal Program">MIT-Portugal Program</OPTION>
<OPTION value="Materials Processing Center">Materials Processing Center</OPTION>
<OPTION value="McGovern Institute for Brain Research">McGovern Institute for Brain Research</OPTION>
<OPTION value="Media Laboratory">Media Laboratory</OPTION>
<OPTION value="Medical Department">Medical Department</OPTION>
<OPTION value="Microphotonics Center">Microphotonics Center</OPTION>
<OPTION value="Microsystems Technology Laboratories">Microsystems Technology Laboratories</OPTION>
<OPTION value="Military Science">Military Science</OPTION>
<OPTION value="Museum">Museum</OPTION>
<OPTION value="Music and Theater Arts Section">Music and Theater Arts Section</OPTION>
<OPTION value="Naval Science">Naval Science</OPTION>
<OPTION value="Nuclear Reactor Laboratory">Nuclear Reactor Laboratory</OPTION>
<OPTION value="Office of Communications">Office of Communications</OPTION>
<OPTION value="Office of Development Services">Office of Development Services</OPTION>
<OPTION value="Office of Educational Innovation and Technology">Office of Educational Innovation and Technology</OPTION>
<OPTION value="Office of Environment, Health & Safety">Office of Environment, Health & Safety</OPTION>
<OPTION value="Office of Experiential Learning">Office of Experiential Learning</OPTION>
<OPTION value="Office of Faculty Support">Office of Faculty Support</OPTION>
<OPTION value="Office of Foundation Relations">Office of Foundation Relations</OPTION>
<OPTION value="Office of Gift Planning">Office of Gift Planning</OPTION>
<OPTION value="Office of Institutional Initiatives">Office of Institutional Initiatives</OPTION>
<OPTION value="Office of Insurance">Office of Insurance</OPTION>
<OPTION value="Office of Leadership Giving">Office of Leadership Giving</OPTION>
<OPTION value="Office of Major Agreements">Office of Major Agreements</OPTION>
<OPTION value="Office of Minority Education">Office of Minority Education</OPTION>
<OPTION value="Office of Philanthropic Partnerships">Office of Philanthropic Partnerships</OPTION>
<OPTION value="Office of Sponsored Programs">Office of Sponsored Programs</OPTION>
<OPTION value="Office of Student Citizenship">Office of Student Citizenship</OPTION>
<OPTION value="Office of the Arts">Office of the Arts</OPTION>
<OPTION value="Office of the Dean for Graduate Education">Office of the Dean for Graduate Education</OPTION>
<OPTION value="Office of the Dean for Student Life">Office of the Dean for Student Life</OPTION>
<OPTION value="Office of the Dean for Student Life - Administratn">Office of the Dean for Student Life - Administratn</OPTION>
<OPTION value="Office of the Dean for Student Life - Dept Heads">Office of the Dean for Student Life - Dept Heads</OPTION>
<OPTION value="Office of the Dean for Undergraduate Education">Office of the Dean for Undergraduate Education</OPTION>
<OPTION value="Office of the Dean of Humanities, Arts & Social Sc">Office of the Dean of Humanities, Arts & Social Sc</OPTION>
<OPTION value="Office of the Executive Vice President & Treasurer">Office of the Executive Vice President & Treasurer</OPTION>
<OPTION value="Office of the General Counsel">Office of the General Counsel</OPTION>
<OPTION value="Office of the Institute Professors">Office of the Institute Professors</OPTION>
<OPTION value="Office of the President">Office of the President</OPTION>
<OPTION value="Office of the Provost">Office of the Provost</OPTION>
<OPTION value="Office of the Recording Secretary">Office of the Recording Secretary</OPTION>
<OPTION value="Office of the Vice President for Finance">Office of the Vice President for Finance</OPTION>
<OPTION value="Office of the Vice President for Human Resources">Office of the Vice President for Human Resources</OPTION>
<OPTION value="Office of the Vice President for Institute Affairs">Office of the Vice President for Institute Affairs</OPTION>
<OPTION value="Office of the Vice President for Resource Devlpmnt">Office of the Vice President for Resource Devlpmnt</OPTION>
<OPTION value="OpenCourseWare">OpenCourseWare</OPTION>
<OPTION value="Operations Research Center">Operations Research Center</OPTION>
<OPTION value="Parking and Transportation Office">Parking and Transportation Office</OPTION>
<OPTION value="Picower Institute for Learning & Memory">Picower Institute for Learning & Memory</OPTION>
<OPTION value="Plasma Science and Fusion Center">Plasma Science and Fusion Center</OPTION>
<OPTION value="Procurement">Procurement</OPTION>
<OPTION value="Program in Media Arts and Sciences">Program in Media Arts and Sciences</OPTION>
<OPTION value="Program in Science, Technology, and Society">Program in Science, Technology, and Society</OPTION>
<OPTION value="Program in Writing and Humanistic Studies">Program in Writing and Humanistic Studies</OPTION>
<OPTION value="Property Office">Property Office</OPTION>
<OPTION value="Public Service Center">Public Service Center</OPTION>
<OPTION value="Registrar's Office">Registrar's Office</OPTION>
<OPTION value="Religious Life">Religious Life</OPTION>
<OPTION value="Research Laboratory of Electronics">Research Laboratory of Electronics</OPTION>
<OPTION value="Residential Life Programs">Residential Life Programs</OPTION>
<OPTION value="SHASS Department Heads">SHASS Department Heads</OPTION>
<OPTION value="School of Architecture and Planning">School of Architecture and Planning</OPTION>
<OPTION value="School of Engineering">School of Engineering</OPTION>
<OPTION value="School of Engineering - UPOP">School of Engineering - UPOP</OPTION>
<OPTION value="School of Humanities, Arts, and Social Sciences">School of Humanities, Arts, and Social Sciences</OPTION>
<OPTION value="School of Science">School of Science</OPTION>
<OPTION value="Sea Grant College Program">Sea Grant College Program</OPTION>
<OPTION value="Secretary of the Corporation">Secretary of the Corporation</OPTION>
<OPTION value="Security and Emergency Management Office">Security and Emergency Management Office</OPTION>
<OPTION value="Singapore-MIT Alliance for Research and Technology">Singapore-MIT Alliance for Research and Technology</OPTION>
<OPTION value="Singapore/MIT Alliance Program">Singapore/MIT Alliance Program</OPTION>
<OPTION value="Sloan School of Management">Sloan School of Management</OPTION>
<OPTION value="Spectroscopy Laboratory">Spectroscopy Laboratory</OPTION>
<OPTION value="Sponsored & Genl A/R & Cashier">Sponsored & Genl A/R & Cashier</OPTION>
<OPTION value="Student Activities">Student Activities</OPTION>
<OPTION value="Student Financial Services">Student Financial Services</OPTION>
<OPTION value="Student Support Services">Student Support Services</OPTION>
<OPTION value="System Design and Management">System Design and Management</OPTION>
<OPTION value="Teaching and Learning Laboratory">Teaching and Learning Laboratory</OPTION>
<OPTION value="Technology Licensing Office">Technology Licensing Office</OPTION>
<OPTION value="Technology Review">Technology Review</OPTION>
<OPTION value="Technology and Development Program">Technology and Development Program</OPTION>
<OPTION value="Technology and Policy Program">Technology and Policy Program</OPTION>
<OPTION value="Terrascope">Terrascope</OPTION>
<OPTION value="The Broad Institute">The Broad Institute</OPTION>
<OPTION value="Travel">Travel</OPTION>
<OPTION value="Undergraduate Advising and Academic Programming">Undergraduate Advising and Academic Programming</OPTION>
<OPTION value="VP Information Services & Technology">VP Information Services & Technology</OPTION>
<OPTION value="Whitaker College of Health Science & Technology">Whitaker College of Health Science & Technology</OPTION>
</SELECT> <I>(Sorry, MIT has a lot of departments)</I>
</TD></TR>
<TR><TH align="right" valign="top">...or your major (course):</TH><TD align="left" valign="top">
<SELECT name="client-course">
<OPTION selected="selected" value="UND">Undecided</OPTION>
<OPTION value="1">1</OPTION>
<OPTION value="2">2</OPTION>
<OPTION value="3">3</OPTION>
<OPTION value="4">4</OPTION>
<OPTION value="5">5</OPTION>
<OPTION value="6">6</OPTION>
<OPTION value="7">7</OPTION>
<OPTION value="8">8</OPTION>
<OPTION value="9">9</OPTION>
<OPTION value="10">10</OPTION>
<OPTION value="11">11</OPTION>
<OPTION value="12">12</OPTION>
<OPTION value="13">13</OPTION>
<OPTION value="14">14</OPTION>
<OPTION value="15">15</OPTION>
<OPTION value="16">16</OPTION>
<OPTION value="17">17</OPTION>
<OPTION value="18">18</OPTION>
<OPTION value="20">20</OPTION>
<OPTION value="21E">21E</OPTION>
<OPTION value="21F">21F</OPTION>
<OPTION value="21H">21H</OPTION>
<OPTION value="21L">21L</OPTION>
<OPTION value="21M">21M</OPTION>
<OPTION value="21S">21S</OPTION>
<OPTION value="21W">21W</OPTION>
<OPTION value="22">22</OPTION>
<OPTION value="24">24</OPTION>
<OPTION value="CDO">CDO</OPTION>
<OPTION value="CSB">CSB</OPTION>
<OPTION value="ESD">ESD</OPTION>
<OPTION value="HST">HST</OPTION>
<OPTION value="MAS">MAS</OPTION>
<OPTION value="NIW">NIW</OPTION>
<OPTION value="OR">OR</OPTION>
<OPTION value="PEP">PEP</OPTION>
<OPTION value="RED">RED</OPTION>
<OPTION value="SDM">SDM</OPTION>
<OPTION value="STS">STS</OPTION>
<OPTION value="NONE">None</OPTION>
</SELECT> <I>(Students)</I></TD></TR>
<TR><TH align="right" valign="top">Your role:</TH><TD align="left" valign="top">
<SELECT name="client-role">
<OPTION selected="selected" value="Student">Student (MIT)</OPTION>
<OPTION value="Faculty">Faculty (MIT)</OPTION>
<OPTION value="Staff">Staff (MIT)</OPTION>
<OPTION value="Other">Other (please explain in notes)</OPTION>
</SELECT>
</TD></TR>
<TR><TH align="right" valign="top">Topic:</TH><TD align="left" valign="top">
<SELECT name="topic">
<OPTION selected="selected" value="Loaner Request">I am an MIT STUDENT and would like to request a loaner laptop</OPTION>
<OPTION value="Faculty Special Request">I am a FACULTY MEMBER with a special request</OPTION>
<OPTION value="General Feedback">Other comments, questions, or suggestions</OPTION>
</SELECT>
</TD></TR>
<TR><TH align="right" valign="top">MIT account number:</TH><TD align="left" valign="top"><INPUT maxlength="7" name="client-cost-object" size="40" type="text"></INPUT> <I>(optional 7-digit cost object, if needed)</I></TD></TR>
<TR><TH align="right" valign="top">Concerns specific laptop:</TH><TD align="left" valign="top"><INPUT maxlength="200" name="laptop-id" size="40" type="text"></INPUT> <I>(MIT property tag or S/N)</I></TD></TR>
<TR><TH align="right" valign="top">This is for a specific class:</TH><TD align="left" valign="top"><INPUT maxlength="200" name="class" size="40" type="text"></INPUT> <I>(If for specific class, specify number, e.g. 1.00)</I></TD></TR>
<TR><TH align="right" valign="top">Loan requested until:</TH><TD align="left" valign="top"><INPUT maxlength="200" name="until-date" size="40" type="text"></INPUT><I>Please specify the expected return date.<BR></BR><BR></BR><BR></BR><BR></BR><BR></BR><BR></BR><BR></BR><BR></BR>Note that we cannot loan a laptop out beyond the end date of the current academic semester.</I></TD></TR>
<TR><TH align="right" valign="top">Notes:</TH><TD align="left" valign="top"><TEXTAREA cols="40" name="notes" rows="15"></TEXTAREA></TD></TR>
<TR><TH align="right" valign="top"> </TH><TD align="left" valign="top"><INPUT name="submit" type="submit" value="Send Request"></INPUT></TD></TR>
</TBODY></TABLE>
</FORM>
<P><BR></BR><BR></BR><BR></BR><BR></BR></P>
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