Form Processor 

Equipment Request Form

 

Request Form for Classroom Technology / Audio-Visual Equipment
(for faculty and staff use only
(*) Instructor's Name
(*) Class Code / Event (ex. TEL305/meeting)
(*) Phone
(*) E-mail Address
(*) Building
(*) Room
(*) Start Time [HH:MM AM / PM]
(*) End Time [HH:MM AM / PM]
(*) Day(s) of Week
(*) Date Needed (MM/DD/YYYY)
List Equipment and Accessories
(Use a separate line for each item)
(*) 1.
2.
3.
4.
Special setup instructions
Video / Film Title
VHS	yes no
3/4"	yes no
16mm	yes no
DVD	yes no
Other Format
Catalog Number
Standing Order (repetitive day/time request)	yes no
Start Date [MM/DD/YYYY]
End Date [MM/DD/YYYY]