California State University, San Bernardino

Palm Desert Campus

Request for Instructional Technology Equipment

Software/Hardware

Please Mark all the equipment you need for your instruction during the course of your teaching:

Equipment Type: Audio/Visual Equipment: TV__, VCR__, DVD__, Overhead__ Projector__, Video Projector__

Microcomputer Equipment: CDROM__,Zip drive___,Speaker__,Other___________________,

Printer__

Software:

MS Office 2003 (word, excel, power point, access)__, SPSS14.0__, Other Application__________________

Internet accessibility____

Telecom: Telephone__,Fax__

Quarter/Year: Fall______Winter______Spring______Summer________________

Duration: Only one classs/session (date/time)______________________________

For the entire quarter (date/time)_________________________________

Only some Saturdays (exact date/time)____________________________

Location: Classroom_____Computer Labs______Auditorium_____Others________

Requestor Name (Please Print):________________________Office Location________

Campus Extension:________Other telephone numbers:______________Email address_________

Signature:____________________________Date:______________________________

Office use Only

Request received By: ____________________________________Date_____________

Equipment availability:___________________________________________________