MEDIA REQUEST FORM

Instructional & Information Technology

(Classroom & Event Equipment Ordering)

voice: 909-869-3920 or 3931 / fax: 909-979-6405 / email: mediaorder@csupomona.edu

Website: http://www.csupomona.edu/~ehelp/mediadistribution/index.shtml Scroll down for printable request form.

This request form may be submitted by fax (909-979-6405), by regular campus mail (bldg. 5, room 211), email (mediaorder@csupomona.edu), or in person by Faculty/Staff only. Orders for media equipment WILL NOT BE ACCEPTED FROM STUDENTS. All request must be submitted by 4:00p.m. the day BEFORE the equipment is needed.

FACULTY/STAFF (print)

COURSE CODE:

DEPT. EXT.

FILL IN ONE LINE PER CLASS DATE (please print clearly)

DATE	DAY	START TIME	END TIME	BLDG	ROOM	EQUIPMENT (see codes below)	SPECIAL NEEDS
09/01/03	F	8 AM	9 AM	5	211	PC