Request for a DVD/VHS Television

Please use the form below to request a television. Please fill in the form completely. Notice the requirements below. No exceptions will be made to the TV request policy.

• Requests must be made via this form. No other emails, telphone calls or other form of communications are acceptable.
• Requests must be made a full two days prior to the day needed. NO "DAY OF" REQUESTS WILL BE FILLED.
• Teacher who signs out the equipment is responsible for it. This includes keeping it in their room, making sure that all wires are left alone and returning the equipment with ALL remote controls.
• Teacher may have equipment for only the requested time. Equipment will be taken from rooms once the requested time has expired, no exceptions. If you need it longer, fill in another request.
• Equipment is signed out for the entire day. It is placed in the request room at the beginning of first block. It will be picked up before the end of the student day on the last requested day. Plan accordingly.
• You will receive a confirmation email scheduling your equipment. Please respond to that email with questions.

Your name:

Your e-mail Address:

Room Number (input first and last room you are in if you float):

Date Needed (mm/dd/yy):

Number of days needed (if non-consecutive, please indicate specific dates in the comments field below):
0 1 2 3 4 5 6

Type of equipment needed:

VCR Only
DVD Only
DVD/VCR Combo
LCD Projector

Additional instructions/requests: