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Educational Technology

Media Equipment Use Request Form

(For Academic Use Only)

Please review the Media Equipment Management Policy to understand the procedures involving equipment use and training requests and to ensure proper use of equipment.

To request audio and video equipment, please complete the form below. We will contact you to confirm availability.

Requestor Information:

Name
Phone
Email
Department

Check the equipment you are requesting:

Camcorder	LCD Projector
Cassette Recorder	Overhead Projector
CD Player	Presentation Navigator
Digital Camera	Projection Screen
Digital Voice Recorder	Slide Projector
DVD Player	Smartboard Wireless Slate
ELMO Digital Projector	Tripod
Extension Cord	VCR
Laptop Computer	Wireless Mouse
Laptop Computer and LCD Projector

Other Equipment (Please explain)

Intended Time of Use:
Date(s):	to
Time:	From (e.g., 10 a.m.) To
Service Location:
Building:
Room:
Other Location:
Additional Information: