University of Massachusetts Medical School

Communication Technologies Department

Pager Acceptance Agreement for Student Pagers

I acknowledge acceptance of my new Alpha-Numeric pager from the Communication Technologies Department. I accept and understand that following:

I will be held responsible for the loss, and/or damage to my pager while in my possession.

I understand that my pager is non-transferable.

Student pagers must be returned to the Office of Student Affairs upon completion of the last scheduled Core Clinical Experience.

Standard Lease Fee - $5.00 per month

Payment of $60.00 is due when the pager is picked up which covers the first year of lease.

Check made payable to "UMMS Student Pagers"

There is a $40 lost/damaged beyond repair pager fee that will be assessed to the student for any pager that is not returned to the Office of Student Affairs. This lost pager fee is in addition to any monthly leasing fees that would be assessed.

I have read this Pager Acceptance Agreement and agree to the terms stated above.

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Please print your name here and sign below

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Student's Signature	Date

All pager transactions [requests, returns, replacement, changes] must go through Student Affairs. As part of the ‘Certification for Graduation’ process, Student Affairs is responsible for verifying your pager was returned and applicable fees are paid. If you don’t return your pager to us, we won’t be able to sign off on that graduation requirement for you.

10 digit Pager #_____________________________