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Audio/Visual Request for Classrooms

Use this form to request computer and audio-visual equipment for use in classrooms. This form must be completed and submitted within 72 hours of delivery. This form is for reservations only. The Media Center does not guarantee delivery until after the confirmation of reservations. Reservations are confirmed after checking availability.

Contact/Request Information
Contact Person:
UIW Extension:
UIW Email:
Date of Delivery:
Delivery Time:
Return Date:
Return Time:
Location: 
   
If event is to be videotaped or photographed by the Media Center, please contact Adela Gott at ext. 3946

Equipment/Screen Requested
Wireless Laptop Computer Qty:
Laptop Computer without wireless capability Qty:
DVD VCR Combo Qty:
Small Speaker System Qty:
Polyvision Panel Qty:
Overhead Projector Qty:
Boom Box Radio Qty:
Presenter Qty:
LCD Projector Qty:
Document Camera Qty:
Screen Qty:
Other: Qty:
Other: Qty:
Other: Qty:
   
General Comments:

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