TEMPLE UNIVERSITY AMBLER
INSTRUCTIONAL SUPPORT SERVICES
AUDIOVISUAL EQUIPMENT REQUEST FORM

Please provide at least 24 hrs. notice for all requests.
Thank You!

INSTRUCTOR INFORMATION

First Name:   Last Name:   Department:

Office Phone:   Home Phone:   E-mail address:

COURSE INFORMATION

Department: Course Number:   Section Number:   Course Title:

Semester: Fall Spring Summer I Summer II   Year: 2006 2007 2008   Days: Monday  Tuesday  Wednesday  Thursday  Friday  Saturday  Sunday

Starting Time:   Ending Time:   Building:   Room:

EQUIPMENT NEEDED
(Check all that apply)

Smart Cart      Overhead Projector     Slide Projector     DVD Player and Monitor     VHS Player and Monitor     Video Recorder

Audiocassette/CD Player (Boombox)     PA System     Microphone and Stand     Flip Chart and Easel

Other:

EQUIPMENT USE

Will you need the classroom for every class meeting or for specific dates?
If you will be requesting the classroom for specific dates, please indicate those dates below.

Every Class              Specific Dates     Please list dates: