Form Center

2. Form Instructions

   Submit this form for CCL programs which require the use of laptop(s), projector, and cable. The form should be submitted at least 3 days in advance of program date.
   
   Include the total of laptops that you need. Mobile lab includes 6 laptops. Presenters will either use their own laptop or the Struble Room podium laptop. Please contact the John W. Jacobs Technology Center at 4395 when your program is over.  Your help with set up and tear down is appreciated.  Thank you!.
   
   The form will be submitted to Sara Lim Harden. Thanks for your cooperation.

4. Program Title*
5. Program Date*
7. Program Time*
8. Program Location*

   1. Struble Room

   1. Burke Room
10. Your Name*
11. Will you be in the workshop?*

    1. Yes

    1. No
13. Name of facilitator
14. Your E-mail*
16. Phone number*
17. Set up time*
19. Tear down time*
20. Is Program Presenter using own laptop?*

    1. Yes

    1. No
22. CCL Equipment Needed*

    1. Mobile Lab laptop(s)
    2. Struble Room Projector Cable
    3. Struble Room Podium laptop
    4. Struble Room Microphone
    5. Burke Room laptop
    6. Burke Room Projector Cable
23. How many Mobile Lab Laptops are to be used?*
25. What time is Presenter arriving?
26. Laptop Location in Struble Room

    1. Front

    1. Back
28. Sound Needed?*

    1. Yes

    1. No
29. Special Notes
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field