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   
Laptop:  Laptop  
  Adapter    
Interactive  Clickers    
  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: