Emergency Calculator Loan Program * – indicates a required field. Please use your student email. Name* First Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Student ID:* Student Email* GPA PhoneFinancial Aid?* Yes No Who referred you to this program* Reason for Calculator loan request:*Consent* I agreeBy signing this agreement, you are acknowledging that this calculator is the property of Camden County College Department of Student Services and must be returned to the Tutoring Center, Taft Hall 107 by the end of the semester. Replacement Fees: Note by signing this agreement you agree to return the calculator to the Tutoring Center by the end of the semester or you will be responsible for the cost of the calculator ($149.00) a bill will be submitted to the business office and a Student Affairs hold will be placed on your student account till the bill is paid! Signature Reset signature Signature locked. Reset to sign again CAPTCHAEmailThis field is for validation purposes and should be left unchanged.