Dickerson-Johnson Library

Media / Equipment Request

 

Administrator, Faculty, or Staff only

If you would like the library to supply you with AV or computing equipment, a CD/video/DVD, or other
equipment, fill out the form below. We'll contact you to let you know if we can fulfill your request.

 

Name  (last, first middle)
 Department / Major
Campus address
 		Campus e-mail
Campus phone
Fax / Other phone


Course title
 Course number
Section number
Number of students

Date      Time to

Location  

 

Film / Video / DVD

Call number / Catalog number
 Title

 

Equipment

Projectors  (e.g. LCD, 16mm, overhead, slide)

Video players  (e.g. VCR, DVD, camcorder)

Audio players / recorders  (e.g. CD, cassette, record)

Computing equipment  (e.g. laptop)

Misc. equipment  (e.g. extension cord, screen, easel)

Comments / Special instructions

Office Use Only

Model #: __________________ Serial #: ____________________

School Code: ______________ Return date: _________________

Operable: _____ Inoperable: ____ Needs repair: _______

  
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