Equipment Request Form

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Faculty Technology Center

Name
Phone #
E-Mail Address
Office Location
To Be Used in Room #
Checkout Date
Equipment Requested
Checkout Time	Morning (8 a.m. - Noon)
	Afternoon (Noon - 4 p.m.)
	Evening (4 p.m. - 10 p.m.)
Return Date
Will you be using the Internet?	Yes No
Purpose of Equipment Loan
Professor Presentation	Student Presentation
	Trip Documentation
	Professor Research
	Student Field Experience
	Student Presentation
	Other
Additional Information