Office of Technology

Classroom Media Request Form

Please note: To ensure your request for equipment or additional media services is processed in time for your class or event, please complete this request at least 48 hours prior to your scheduled class or event. Please call the Service Desk at (815) 836-5950 for further assistance. Thank you.


Instructor's Information

* Required Fields

* First Name


*Last Name


* Phone Number
( ) - ext:

* Status


* Email Address





Classroom Information

Building


Room Number


Day(s) of use
Sun
Mon
Tue
Wed
Thu
Fri
Sat

Start Date


End Date


Start Time


End Time


Media Support
MS PowerPoint / Projector
Video
Internet Access




Other Comments / Instructions