Media & Equipment Request Form

This request form may be used to request media and equipment for Augustana classroom use. 




    Bar code #:  



          Name:  



        Status:  

         (Students MUST have a signed equipment release form before delivery.)



         Dep't:       Building:  



         Phone:    E-mail:  




MEDIA



         Title:  



        Format:  




EQUIPMENT

       Needed:   



* select up to 4 items, if more are needed please include 

them in the remarks selection below; you may select multiple 

items by holding down the Control key on Windows computers or the 

Apple key (Command key) on Macintosh computers





  Date Needed:        Time/deliver by:   

                 [mm/dd/yy]              Time/pick up:   

  

    Delivery location (Building and room #):   

             Pickup location (if different):   

 

   Other info:

You should receive a phone call from Media Services staff confirming this request. If you do not get a call at least 24 hours before you need the requested items, please contact Media Services at 4920. We will do everything possible to fill media and equipment requests. Thanks!

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