Device Loan Request





This form should be used to request loan of Android devices, power packs and 3G Wifi dongles




Please enter the name of the project


Please indicate how many phones you would like to borrow.


Please indicate how many tablets you would like to borrow.


Please indicate how many 10,000 mAh power packs you would like to borrow.


Please indicate how many 20,000 mAh power packs you would like to borrow.


Please indicate how many 3G WIFI dongles you would like to borrow.


Please enter the expected dates for the loan period
(yyyy-mm-dd)
Start
End


Please give the name and email address of the principal investigator/ project supervisor of the study
ALL Students must enter the name of an LSHTM staff member who is willing to act as PI.

PI Name

PI Email

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