Equipment Loan Program (Click Here for Loan Program Options)

This form is only intended for individuals wishing to request transportation related assistance.

Important: This form is NOT intended for requesting general UConn information.

Unless noted by an asterisk(*) all form fields are required

First Name: *M.I.
Last Name:
Title:
Agency or Municipality:
Address:
City:
State:
Postal/Zip Code:
*Country:
Phone:
*Fax:
Email:
Please Specify Your Equipment Loan Request(type in the box below):
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Technology Transfer Center
270 Middle Turnpike, Unit 5202
Storrs, CT 06269-5202
(860) 486-5400