SUNY Brockport MetroCenter

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Audio/Video Request Form

Requestor Information
Name:
Department:
E-mail Address:
Type:	Faculty/Staff Student Other
Course:
Daytime Phone:
Evening Phone:
Please do not use your Social Security Number on this form.
Banner ID (if student):
Request Logistics
Please reserve only for time blocks during which equipment will be used.
Date(s) needed:
Times needed:
Room:
Equipment Requested
Note: Equipment is subject to availability and is assigned on a first-come, first-served basis. Please use the checkboxes to select your equipment.
Computer Equipment:	Computer w/LCD Projector SmartCart Wireless Presentation Remote

Television Equipment:	TV DVD VCR	Remote (DVD/VCR) Extension Cord
	TV DVD VCR	Remote (DVD/VCR) Extension Cord
Projectors:	Overhead Projector LCD Projector (w/o comp) Slide Projector
Other: Note: Digital Camera is available to faculty only.	Cassette Player/Recorder Camcorder/Tripod Digital Camera
Training
I have been trained to operate the requested equipment by MetroCenter Technology Staff	Yes, I have been trained No, I do need training
Accessibility
Does requested equipment require closed-captioning activated?	Yes No
Please indicate any other ADA needs:
Liability
I understand that, as borrower of this equipment, I may be liable for any damage or loss
Submit Request to the MetroCenter
Please submit A/V requests at least one week before date needed.

The College at Brockport

350 New Campus Drive, Brockport, NY 14420