EQUIPMENT RESERVATION FORM
  
 
   SELECT   EQUIPMENT
If you need more then one of the SAME item, you MUST make another reservation for it.
 20 Station Laptop Cart Tripod              
 STAT-Cart (SPSS,SAS,nVivo,Mplus) Video Tele-Conference Device              
 Ruffner Hall (ONLY) Data Projector Digital Audio Recorder / Dictaphone              
 Ruffner Hall (ONLY) Laptop TV/VCR              
 Portable (Off-Site) Data Projector Portable Overhead              
 Off-Site Laptop Slide Projector              
 Digital Still Camera 16 MM Projector              
 Digital Camcorder Axim (PDA) Cluster              
   Service, Special Request, or Comments              
     
 
SELECT   RESERVATION DURATION
 
Date Type 
     
 
 SELECT   CHECK-OUT & RETURN  TIMES
  Check-Out Time 
  Return Time 
   
 
ENTER  CHECK-OUT & RETURN  DATES (if applicable)
 
Check-Out Date 
 / /
 
Return Date 
 / /
     
 
SELECT DAYS OF THE WEEK   (for recurring reservations)
 
  Monday 
Friday                                                   
 
Tuesday
Saturday                                                   
 
Wednesday
Sunday                                                   
 
Thursday
 
 
ENTER DELIVERY AND DEPARTMENT INFORMATION
 
Delivery in Ruffner Hall 
    Classroom 
 
Pick-Up  
 
Dept 
     
 
ENTER FACULTY INFORMATION  (required for all reservations)
 
Faculty First Name 
 
Faculty Last Name 
 
Faculty Computing ID 
 
Faculty Phone # 
     
 
ENTER STUDENT INFORMATION (if applicable)
 
Student First Name 
 
Student Last Name 
 
Student Computing ID 
 
Student Phone # 
     
 

ENTER SPECIAL REQUESTS or INSTRUCTIONS
If you need more then one of the SAME item, you MUST make another reservation for it.
 
Requests or Instructions 
      
   
     
     Questions? ....
   Call ETO Equipment Reservations at 924-7086 or  e-Mail us at edtech-support@virginia.edu