Off-Campus Loan Form Off-Campus Loan Form Please complete the form below and click “Submit” on the bottom of the page when finished. Date(Required) MM slash DD slash YYYY Type of Specimen(Required)– please select specimen –BryophytesFungusVascular PlantsRequester's Full Name(Required)Title/Position(Required)Institution Name(Required)Institution Acronym(Required)Address 1(Required)Address 2Address 3City(Required)State(Required)Zip(Required)Country(Required)Email(Required)PhoneDescriptions of Specimens and Remarks(Required)Please provide as much detail as possible (i.e. Specimen numbers, locations, geographic scope, synonyms, expected term of loan etc.)If you are a student, please list your supervisor's information belowFull NameTitle/PositionEmail Δ Donate to the Herbarium
