Classroom Media Equipment Request Form

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media support services Classroom Media Equipment Request Form

Please fill in the form below to request media equipment for classroom use only. 48 hour notice is required for classroom deliveries. Completion of this form does not guarantee delivery of the requested equipment. Equipment will only be delivered after you receive an e-mail confirmation from Academic Media Equipment Services. Borrower is responsible for all equipment from time of delivery until time of pickup.

Please fill out the fields below.

* Required fields

* Person making request
* Phone
* Email
Date of request (mandatory 48 hours before delivery date)*
* Date of Delivery
Date of Pickup	Same day Other:
Delivery Building
Delivery Room
Delivery Time
Pickup Room
Pickup Time
Equipment requested	35mm Projector Boombox with CD & Cassette Camcorder Cart Cassette Recorder Data Projector DVD Player Easel Easel with pad Laptop Computer Laptop Computer with Internet Laptop Computer with External Powered Speaker Record Player TV VCR
Other equipment

Type the characters you see in the picture above: (case sensitive)