CIS Media & ACS Video Services Reservation Form

Request Form

Client Information:

First Name:

Last Name:

Email:

Course Number:

Phone:

Department:

Comments:

Department:

Please check which department this request is directed to:
CIS Media Services ext.3822

ACS Video Services ext.3359

This is an interdepartmental form used for both CIS Media and ACS Video Services.

Delivery Information:

From Date:

MM/DD/YY YY

To Date:

MM/DD/YY YY

From Time:

To Time:

Initial Action:

End Action:

Deliver To:

Pickup From:

Schedule Information:

If you are making a Recurring Order, you must specify a Starting Date for when the cycle begins and an Ending Date for the cycle to terminate.Please keep in mind you must create a reservation request for each day of the week, for example if you have a Monday and Wednesday class at 4:30pm first create your Monday request and submit the completed form and then click on the Media Manager Request link and reenter the info for your Wednesday class.

One Time Only

Daily

Weekly

Every

Monthly

The

of the month(s).

Starting Date:

mm/dd/yyyy

Ending Date:

mm/dd/yyyy

Basic A-V Equipment Information:

	Quantity:	Department:	Category:
1.
2.
3.
4.
5.

Software Installation Requests:

I'm requesting that following software be installed on the Media computer in:

Building:

Room #

Software requested:

All Media Services computers have the following software already pre-installed on their OS:

Adobe Acrobat Reader	Itunes	Penoffice 2.5 (only on Wacom rooms)	SPSS
Adobe Creative Suite	Jzip	Polycom	Skype
Comic Life	McAfee Anti Virus	Power DVD DX (DELL PCS ONLY)	Sonic
Endnote	Microsoft Office 2007	Putty	Safari
IE	Mozilla FireFox	Quicktime	VLC Media Player
Google Chrome	Notebook	Real Player	Windows Media Player
Google Earth	NVivio	Scratch	Windows Movie Maker
Inspiration		Second Life

PLEASE CHECK INFORMATION IS ENTERED CORRECTLY BEFORE SUBMITTING:

Human Check: