AV/Classroom Technology Services Equipment Request Form

Name:

Department:

Phone:

Email:

Reservation Date:

Delivery time: AM PM

May be picked up at: AM PM
(Please note: other reservations may depend on this equipment being picked up promptly - if you feel your event may run long, be sure to include this time in your reservation)

Schedule for every: Until:

Delivery location: Room

Equipment needed:

Additional equipment needed:

Internet connection needed for computer? YES NO
(not provided by default)

Initial assistance needed with equipment? YES NO
(not provided by default)

Please list special instructions or additional information below:

You will receive a confirmation of your request via the email you provided. If you do not receive a confirmation within 48hours, please follow up with AV/Media Services at 546-9440.