One Card Reader Request Form The purpose of this form is to request the use of a One Card reader for an event. Please select UConn Department or Tier III Student Organization:**Note - at this time only Tier III student organizations are eligible. UConn Department Tier III Student Organization Department/Organization Name* I would like to:*Please let us know if you would like to rent the reader for your event or if you prefer to purchase a reader due to the number of events you anticipate. Rent the reader(s) Purchase the reader(s) Event Coordinator Name*Please enter the name of the person that is coordinating the use of the mobile reader(s) for this event. Event Coordinator Email* Event Coordinator PhoneKFS Account Number*Please enter the KFS account number to be billed for this request. Fiscal Officer Name*Please enter the name of the person that is authorized to approve the rental/licensing fee. Fiscal Officer Email* Date of Event*Please enter the date of the event. If there are multiple events or the event is longer than one day, please enter the first date here and the additional info below in special instructions. MM slash DD slash YYYY Start TimeThe time the event begins. : AM PM AM/PM End TimeThe time the event concludes. : AM PM AM/PM Location of Event*Where will the event be held? Number of Readers*How many readers do you need for this event? In the special instructions section, please specify if you would like the iTouch or the iPad Mini. By default, we loan out the iTouch.Please enter a number from 1 to 5.Hotspot Required?If you will be utilizing the mobile reader where you cannot connect to UConn Secure or another wireless network, then you will need to also rent our hotspot. *Please note, the hotspot is an additional $10 fee. Yes Description of Event*Please describe your event and how you would like to utilize the mobile reader. For example, will you be tracking attendance to an event, want to limit attendance based on a certain population, i.e., Seniors, will be accepting Husky Bucks as a form of payment for goods or services, etc.Additional InformationPlease provide any additional information such as additional event dates or if you would prefer the iPad mini. Prior to completing your request, you must read and agree to the policies set forth in the Equipment Use Agreement.Agreement* I Agree to the Equipment Use Agreement. CommentsThis field is for validation purposes and should be left unchanged.