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SUNY Downstate Medical Center

Classroom Services

Classroom Services Online Request Form

A maximum of 3 events per request please.
For events with more than 3 events please print our request form (see link to the left)


One activity per request form

Room and Media Request

Media ONLY Request

Media for already scheduled activity


Contact Information

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 *
Number of Attendees Food
(Y/N)
Equipment
Needed
Room Location to deliiver Audio Visual equipment **
Example:
08/20/05 3:45pm 4:00pm - 6:00pm 5:45pm 100 Y i.e 1, 2, 3 ie: 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 - by Number
1 Computer Projector
Quantity:
5 Document Camera
Quantity:
9 CD Player
Quantity:
2 Podium Microphone
Quantity:
6 Wireless Microphone
Lapel Hand HeldBoth
Quantity:
10 Computer Projection
Quantity:
3 Overhead Projector
Quantity:
7 Flat Screen Monitor
LargeSmall
Quantity:
11 DVD Player
Quantity:
4 Projection Screen
Quantity:
8 Projector Stand
Quantity:
12 Technical Assistance
(Be specific)


Other Needs

Please provide any additional information:


Submit Request

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

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

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