LRC - AV Request Form

Media Scheduling Request

Learning Resources - ext 6660

Please Submit Scheduling Requests at
Least 48 Hours in Adavance

Please Fill Out a Separate
Form for Each Request

	You must fill in every box for the form to be accepted.
Request From:
Department:
Date of Request:
Phone #:
Email:

Dates Needed:

Title, Number, and/or Equipment Needed:

Building and Room:

Time Equipment is Needed

(for example 8 am or 4 pm)

Date to Be Returned:

I accept responbilty to return the instrument/materials within the indicated time or to reimburse the College in the event of loss/theft/damage, unless evidence is provided that responsible precautions were taken to protect the property in my possession. I further certify that the use of this instrument/materials will be for official college business in compliance with teh U.S. Copyright Law and shall be in conformity with established college procedures pursuant to college policy 6Hx2-6.21.