Equipment Request Form
Created by the Classroom Support Pilot Project
(Required fields are marked in
bold
.)
Name:
Course Number:
Extension:
e.g. x51234
Email address:
e.g. name@host.domain
Building:
-select-
Jimenez
Francis Scott Key
LeFrak Building
Marie Mount Hall
Skinner
Taliafero
Tawes
Woods Hall
Room Number:
Department:
-select-
American Studies
Linguistics
Philosophy
none
I need a:
Computer
VCR
DVD Player
LCD Projector
Preferred computer type:
Windows
Mac
I would also like:
Internet
ZIP Drive
Floppy
This equipment will be used for :
A lecture
Student presentations
A guest speaker
Additional requests or instructions:
I recieved my equipment promptly:
I agree
I disagree
I am undecided
I would recommend this service to others:
I agree
I disagree
I am undecided