Programs that begin before 8:00 a.m. or end after 5:00 p.m. may incur additional charges and require a Chart Field Combination number to be provided below.

Start Date		End Date
	(mm/dd/yyyy)		(mm/dd/yyyy)

Start Time	: AM PM	End Time	: AM PM

Days Required:

Mon Tue Wed Thur Fri Sat Sun

Confirmed Building & Room Number:
[ Required ]

Equipment Requested

LCD Multimedia Projector	Computer
Television	Wireless Microphone
VHS Player (Standard 1/2)	Document Camera
Internet Access	Portable Audio System
Phone Conference Device	Cassette Player
Laser Pointer	Audio Recording
DVD Player	Podium
Wireless Mouse	Easel and Flip Chart
Microphone	Overhead Projector
Projection Screen	X-Ray Panel
Classroom Performance System

Additional Equipment Information

Internet Access Point Wall Plate Number

Telephone Access Point Wall Plate Number

Classroom Performance System (CPS) Number of Students in Class

Billing Information [if needed]

Campus Department, Chart Field Combination Number (CFC)

MCGHI Department, Billing Information to include Account Number

Other Requirements or Comments

Please Note: All requests must come through the submission process (not through e-mail). If you receive a submission error instead of the submission confirmation page, please try to re-submit. If you continue to encounter problems contact the IT Service Desk at 1-4000.


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Request for Audiovisual Equipment

June 26, 2008