Add New Equipment Request
Before filling out the rest of this form, please double-check the Check-Out calendar for availability

Before You Start--Please type "OTEN" (all caps, no quotes) in this box:

Date/time equipment will be picked up

Month: Date: Year: Pickup Time:

Date and time equipment to be returned

Month: Date: Year: Return Time:


Name of Requestor
Last Name: First Name:
email (confirmation message will be sent to this address):


Equipment Requested

Laptop(s)

Zip Drive(s)

Digital Still Camera(s)

Digital Camera Six-Pack
Sony Direct-to-DVD Video Camera #1
Sony Direct-to-DVD Video Camera #2

Regular Digital Video Camera(s)

Tripod(s)

Linksys #1 (Wireless Network Base Station)
Linksys #2 (Wireless Network Base Station)
Powerpoint Presenter(s) Portable Printer
InFocus Projector
Hitachi Projector #1
Hitachi Projector #2 		CDRW Burner w/Firewire
Scalar Digital Microscope Intel Digital Microscope
Equipment Cart(s)

 Palm Pilot(s)
Wireless Microphone

 Flash Drives(s)
iBook

 Document Cameras
Avermedia
ELMO


Information to Help Us Serve You Better

Grade Level for which equipment will be used :
How will you use this equipment?*now required

What is your objective for learning?*now required

* I agree to return all the equipment in good working condition.