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Classroom Support Services

*Required Fields

 *Name:
 *Email:
 *Phone Number:
 *Day of Class: mm/dd/yy  
 *Pick Up Time:
 *Return Time:

  

 

Equipment Needed: 

 

Audio:

Tape Recorder
  Dictaphone (micro cassette)
  CD Recorder
  Mini Disc Player
 Camera: Still, Digital
  Video, Digital
  Video, VHS 
 Projectors: LCD/Data
  Overhead
  Slide
 Video Playback: DVD 
   VHS 
Interactive Remote Presenter  


Special Instructions: 

 

  Office Use ONLY  
To be completed upon pick up of equipment:

MY SIGNATURE CONFIRMS THAT I HAVE RECEIVED THE ABOVE STATED EQUIPMENT AND THAT I ASSUME RESPONSIBILITY FOR IT, INCLUDING ALL DAMAGES AND/OR LOSS OTHER THAN WHAT MAY RESULT FROM NORMAL WEAR. 
Signature:  
PEID:  
Description: