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 (a confirmation message will be sent to this address):


Equipment Requested

Laptop(s)

Wireless Base Stations
Computer Projector Computer-TV Monitor
imac Cart w/ Projector Lap Top Cart (faculty only)
LaCie 120GB Hard Drive Iomega 250GB Hard Drive

Digital Video Camera(s)

Digital Still Camera(s)

PALM Pilot (s) Zip Drive(s)
Scanner(s) Tripod(s)
Wireless Microphone QPS DVD Burner w/Firewire
Wacom Art tablet Lexmark Color Printer
Avervision 110 Document Camera Labpro and Vernier Probes
Scalar Digital Microscope QX3-Digital Blue Microscope
Midi Keyboard (49 key) JVC External Speakers (pair)
TI Graphing Calculator Viewscreen Wireless Keyboard
Pyro A/D Video Converter (we have 2) Dazzle A/D Video Converter
iSight Camera (we have 2)

iPod(s)



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.