VCOM Institutional Policy and Procedure Manual

Office of Research Administration 2265 Kraft Drive

Blacksburg, VA 24060 Phone: 540.231.8239 Fax: 540.231.5338 www.vcom.edu/ora

REQUEST TO TRANSFER EQUIPMENT TO ANOTHER DOMESTIC INSTITUTION

Please complete the below information for the equipment you wish to transfer from the College and the “Detail Equipment Request to Transfer” for each equipment item. If you have questions, please contact Greg Reaves (540-231-8239).

Transfer Requested by:____________________________________________________________

Division:

____________________________________________________________

Department Number: ____________________________________________________________

Total Dollar Amount of Equipment to be transferred: ___________________________________ (Attach Detail Equipment Request to Transfer Form)

Receiving Institution: ______________________________________________________ Receiving Institution Address: ______________________________________________________ ______________________________________________________

Contact at Receiving Institution: ________________________________________ Contact Telephone Number/Email: ________________________________________ Effective Date of Transfer: ________________________________________

Original Funding Source of Equipment:

☐ Federal

☐ State

☐ Private

☐ Donation

If the sponsor retained title to the equipment, please attach written authorization to transfer the grant/contract related equipment to the other institution.

Edward Via College of Osteopathic Medicine