Carlow IT - Media Center Equipment Order Form

Media Center

Equipment Order Form

Please type your information into text entry areas. For drop-down selections, click the arrow head to right of selection shown and then click on your choice. For radio buttons, click one button per question. Click Submit Order button to send to the Media Center.

All items with an * (asterisk symbol) on this online form are required and must be completed.

Instructor Information

Last Name*

First Name*

Department*

Program*

Carlow Ext.*

Home Phone

E-mail*

Day/Time

Date Needed*

If recurring, Repeat until:

Repeat

Every Week on
Every Weekday (M-F)
Every Day

Starting Time*

Ending Time*

Event Name:

e.g., Service Learning Day, Orientation, etc.

Location of Equipment

Building*

Room*

Equipment Needed

LCD projector (computer/video)	Laptop computer/internet access/Office XP
Presentation Remote	Turning Point ("clickers")
Television	VHS/DVD player
PC Microphone	Microphone
Speaker	St. Agnes Sound System
AJP Atrium Speaker System	Stereo system
VHS camcorder	Cassette Recorder
Mini DV camcorder	Tripod
Mobile Lab (Aquinas only)	Digital Camera
Document Camera	Audiocassette recorder/players
Boombox (CD/cassette/radio)	Wireless microphone (lapel & regular)
Overhead projector	35mm slide projector with accessories
Laser disc player	External Zip drive
Phonograph (record player)	16mm movie projector
Screen

Operator Needed?* Yes No

Special Instructions:

*Indicates a required field and must be completed to continue

Click Submit Order button to complete your order for equipment. Please be patient after you click Submit button. It may take a few seconds for the confirmation screen to appear.

Contact Information:
Antonian Hall, 2nd Floor
Phone: 412-578-6147
Fax: 412-578-6310
Email: mediacenter@carlow.edu

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