AudioVisual Equipment Request Form

1) Instructions:

	Electronic Forms must be submitted at least 2 business days before date of use or checkout. Individuals requesting items with less than a 2 business day notice must also contact AV Services directly at 966-6536, or in Rosenau 233.
	1) Complete the form, providing all applicable information requested;
	2) After entering all information, press the “Submit” button at the end of the form.
	* = Required information.

2) Your Contact Information:

	* Requestor's First Name	* Last Name


	* Daytime Phone Number	* E-mail


	Course or Activity for which you are requesting this activity

	* University Status
	Faculty Staff Student Teaching Assistant
	* Department or Major

3) Date(s) and Time(s) of Your Requested Reservation:

	A) This is a request for ONE block of time, e.g., 1 class period; 2 successive days; 1 week. For a 2nd date or times, please submit a 2nd request.
	B) Individuals making “full-semester” or multiple repeating requests should NOT use this form. Individuals with these types of requests should contact AV Services direclty at 966-6536, or in Rosenau 233.
	Hours of Operation: Monday-Friday, 8:00 AM to 5:00 PM. NOTE: AV Service Staff is NOT available during weekend hours. Please schedule all Start and End Times as well as equipment demonstrations during hours of operation.

	Start Date = Date your class or event starts; OR, date you will check out the equipment from Rosenau 233.
	End Date (For same-day use, enter same date) = Date your class or event ends; OR, date you will return the equipment.
	* Start Date (mm/dd/yyyy)	* End Date (mm/dd/yyyy)

	Setup/Checkout Time = Time by which you want equipment set up (i.e., time your activity or your room reservation starts), OR, time you will actually check out the equipment from AV Services office.
	* Start Time (hh:mm AM/PM)

	End/Checkin Time = Time your classroom activity ends, OR, time you will actually be returning the equipment.
	* End Time (hh:mm AM/PM)

NEED EQUIPMENT ALL SEMESTER FOR A CLASS, or ON A LONG-TERM REPEATING BASIS?—Please contact AV Services directly in Rosenau 233 or at (919) 966-6536.

4) Delivery (A), or Checkout (B), of Equipment:

	A) Delivery and set up will be provided by AV Services for SPH classroom, conference room, & auditorium use only. (No delivery/set up in Hooker Lab area, to which AV Services does not have access.)
	B) For checking equipment out of the building, please bring your UNC OneCard for your first checkout.
	Please NOTE: PowerPoint Remotes and Laser Pointers are “Checkout Only” items.
	A) Delivery? Choose one building, then add room #:
	Hooker (Enter room # .)
	McGavran-Greenberg (Enter room # .)
	Rosenau (Enter room # .)
	B) or Checkout?
	Check Out and Check In equipment at Rosenau 233, the AV Services office.
	Where will you be taking the equipment?

5) Delivered AV Equipment used in SPH, beyond 5:00 PM:

	Please NOTE: Equipment must be secured by YOU, AND retrievable the next morning by AV Services. Please list the secure SPH room # where you will lock up equipment overnight.

6) Equipment to be Reserved:

Select item(s) by clicking the pull down menu(s).

NOTE: View listings of equipment installed in the classrooms at: www.sph.unc.edu/iis/ims/classroomtechnology.htm.

Special Considerations:

A) For Laptop Requests—
Please check the options listed below in the next section, “Laptop Options.”

B) To Request an equipment demo—
Check the box below.
Please contact me for a demonstration of equipment.

C) Conference Speaker Phone, Important NOTE—
Will only operate in rooms having a standard analog phone line. Please contact AV Services at 966-6536 for a list of rooms with analog lines.

First Item

Second Item

Third Item

Fourth Item

Other: Equipment not listed in the dropdown menus above

Briefly, how will you be using the requested item(s)? (Optional)

Laptop Options... List the drive(s) you need:

	Select the item(s) that will be needed with the requested Laptop. Please NOTE that all AV Services' Laptops have USB ports. However, not all USB “memory sticks” are 100% compatible with all computers.
	Zip 100 Drive
	Zip 250 Drive (Can also read Zip 100 discs)
	CD-ROM Drive (NOT guaranteed to read all CD-RW discs)
	DVD Drive (Can also read CD-R discs)
	Floppy Disk Drive
	Ethernet Cable