UW-Madison EOC Shared Resource Support Team Inventory Collection Form Contact InformationName* First Last Phone*Email* What department are you with?*What MD number are you using?*Information about what you are providingWhat items are you providing?***Please do not use parentheses**Item Name / DescriptionBrand / Model # / Size (if applicable)Quantity Are these item(s) a donation?*Yes, I do not want these items to be replacedNo, I would like these items to be replacedYou selected no, please tell us what item(s) you would like replaced once the University returns to normal operation.*Were these items purchased with federal funds?*YesNoYou selected Yes, please tell us which item(s) were purchased with federal funds.*