Please complete all the information below.

Name:   

E-mail Address:  

Department:  

Equipment Need: 
Television VCR DVD Player Overhead Projector
Easel and Pad 16mm Film Projector Slide Projector Projector Screen

Building and Room Number where equipment is to be used:

Start Date

End Date

Please select the method pick-up and return of equipment:
  I will come to the library to pick up and return the item. I will contact maintanence to request pick-up, and again later to return the equipment.

By submitting this form, you assume responsibility for this equipment from the time it leaves the library, until the time it is returned.

Requests for Instructional Media items should be placed at least one university business day (Monday-Friday) prior to date you first desire access to the equipment.