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:

Use these boxes to request equipment for a single date or continuous series of dates

Date/time equipment will be picked up:
Month: Date: Year: Pickup Time:

Date and time equipment to be returned:
Month: Date: Year: Return Time:

FACULTY ONLY: Use these boxes to request equipment for a certain day of the week (e.g., "every Tuesday") during a series of months
Day:
Starting in:Year:
Ending in:Year:
Pickup Time: Return Time:


Requestor Information
Last Name: First Name:
email: Phone (home):
Phone (school): Select Area:


Equipment Requested

Laptop Computers #2-10
(12" iBook)
#2
#3
#4
#5
#6
#7
#8
#9
#10
Laptop Computers #13-15
(14" iBook w/superdrive)
#13
#14
#15 		Laptop Computers #1, #11 & #12
(13" MacBook w/superdrive)
#1
#11
#12
Digtal Camcorders
Digital Camcorder #1
Digital Camcorder #2
Digital Camcorder #3
Digital Camcorder #4
Digital Camcorder #5
Digital Camcorder #6
Microphone
Digital Still Camera--Fischer Price
Digital Still Camera--Canon A80 		Tripod
Boombox Airport Base Station
Digital Microscope
Other:

Equipment Requested (Faculty Only)

Dell Projector (small) Dell Projector #1


Information to Help Us Serve You Better

Comments
I will be using this equipment in my teaching placement. Grade Level for which equipment will be used :
How will you use this equipment?

What is your objective for learning?
* Please understand that you are accepting responsibility for the above items and will be held financially responsible in case of their loss.