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Classroom Services Online Request Form

 

ONE ACTIVITY PER REQUEST FORM

  

Room and Media Request Media ONLY Request Media for already scheduled activity
Name of Contact Person: 
Today's Date: 
Phone #: 
Room #: 
HSCB Box # 
Fax #: 
E-Mail
College/Division: 
Department: 
Name of Activity: 

  Room User Information

Name of Actual Room User: 
Phone #: 
E-Mail
Department
Affilliation (i.e. visiting)

Event Details

Date
*Prep Time
Start Time- End Time
*Cleanup Time
# Attendees
Food (Y/N)
Media
*Room Location to deliiver Audio Visual equipment
08/20/05
3:45pm
4:00pm - 6:00pm
5:45pm
100
Y
i.e 1,2, 3,
i.e. AV Shop EB64

* Prep and clean time will not appear on confirmation, it is expected that you will leave the room in the condition received.

* When requesting equipment only, rooms other than Classrooms or Lecture Halls, please give the room name and room # (i.e.AV Shop EB64)

Equipment Needed

   
Equipment
Quant.
 
Equipment
Quant.
 
Equipment
Quant.
1
Slide Projector
5
Audio Cassette Player
9
View Box
2
Microphone
6

TV/VCR-

VHS 3/4

10
Computer Projection
3

Overhead Projector

7

Video Projection

VHS 3/4

11
DVD Player
4
Projection Screen
8
Document Camera
12

 

Technical Assistance

(Be specific)

Other Needs Please provide any additional information :  

When this information is correct, click here to submit your request.


It may take a short time to process this form.  Please be patient.