CLASSROOM SERVICES REQUEST FORM

ONE ACTIVITY PER REQUEST FORM

   

Room and Media Request Media ONLY Request Media for already scheduled activity

Today's Date: 

Name of Contact Person: 
 

Phone #: 
Room #: 
HSCB Box # 
Fax #: 
E-mail

 

College/Division:  Department: 

 

  Name of Event: 
 



  Room User Information

Name of Actual Room User: 
Phone #:  E-Mail

Department Affilliation (i.e. visiting)


Event Details

Date
*Prep Time
Start- 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
Computer Projection
5
Document Camara
9
Audio Cassette Player
2
Overhead Projector
6
Microphone
10
DVD Player
3
Projection Screen
7
TV/VCR- VHS 3/4
11
View Box
4
Slide Projector
8
Video Projection
12

Technical Assistance

(Be specific)

 

Other Needs

 

Please provide any additional information below:

 
 

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


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