CenterNet | AV | Request Form

Oklahoma State University
Center for Health Sciences

Service Request Form

Name:	Date Requested:	Date Needed:

Phone:	Time Needed:
	-
Email:	Class/Room #:	Course ID:

Type of Presentation: (computer, video, audio, etc.)	Is this request the same day and time every week?
	Yes No
Check all mobile presentation equipment that applies:
Cart Flipchart(s)-How many? Audio Cassette Recorder Overhead Projector Digital Voice Recorder LCD Projector CD Player Portable Screen PC Computer (MAC adapters available upon request)	Portable Whiteboard Laser Pointer Easels(s)-How many? 35MM Slide Projector Extension Cords(s)-How many? Television & DVD/VCR Player Sound System Laptop Computer Video Camera Digital Camera

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