Curry ETO Equipment Reservations


	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	Digital Audio Recorder
	STAT-Cart (SPSS,SAS,nVivo,Mplus)	TV/VCR
	Portable Data Projector	Portable Overhead
	Laptop	Slide Projector
	Digital Still Camera	16 MM Projector
	Digital Camcorder	SmartBoard
	Tripod	Document Camera
	Video Tele-Conference Device	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
	Equipment will only be delivered to rooms listed in the Classroom dropdown list.
	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