• To accept individual responsibilities associated with using university-provided personal technology and telecommunications equipment and services or being reimbursed for wireless telecommunications services.
  • This form must be signed by the recipient prior to obtaining the approved equipment and/or service. Note: Regents of the University use the Personal Technology Regent Responsibility (PTR) form instead of this form.
  • For additional guidance see the Finance Procedural Statement Personal Technology and Telecommunications.


When the form has been successfully submitted, you will receive an email confirmation that you can share as appropriate.

Each of the following responsibility statements must be checked in order to certify the recipient's agreement and submit the form.


By clicking "Submit" below, I acknowledge that I have reviewed the University's guidelines and requirements for Personal Technology and Telecommunications. I further certify that I understand, and promise to abide by, the responsibility statements listed above.