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 7 days in advance of program date.
   
   Include the total of laptops that you need. Mobile lab includes 12 laptops. Presenters will either use their own laptop or the Struble Room podium laptop You must let us know in person that your program is over and that tear down can begin. Your help with set up and tear down is appreciated.
   
   The form will be submitted to Sara Lim Harden. Thanks for your cooperation.
4. Program Title*
6. Program Date & Time
   Program Date & Time Start Date

   Program Date & Time Start Time

   —

   Program Date & Time End Date

   Program Date & Time End Time
8. Program Location*

   1. Struble Room
   2. Burke Room
   3. Small Conference Room
10. Your Name*
11. Will you be in the workshop?*

    1. Yes

    1. No
13. Your Email Address*
14. Your Phone Number*
16. Set-Up Time*
17. Tear-Down Time*
19. Equipment Needed

    1. Mobile Lab Laptop(s)
    2. Struble Room Projector Cable
    3. Struble Room Podium Laptop
    4. Microphone
    5. Burke Room Laptop
21. How many Mobile Lab Laptops are to be used?*
22. Date and time the equipment is to be picked up?
    (If Applicable)
24. Is Program Presenter using own laptop?*

    1. Yes

    1. No
25. What time is Presenter arriving?*
    What time is Presenter arriving?
27. Training for equipment use needed?

    1. Yes

    1. No
28. Laptop Location in Struble Room

    1. Front
    2. Back
30. Special Notes
Leave This Blank:


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

    This field is not part of the form submission.

34. Submit

* indicates a required field