Faculty & Staff Home | Instructional Support | Resources | A/V room | AV Request

AV Equipment or Support Request Form

A/V equipment or support requests should be made at least 48 hours in advance. For questions or assistance, contact Sam Brill, A/V Technician at sbrill@dental.ufl.edu or 392-2869 or the Office of Education at 392-2949. This form helps the Office of Education for keeping track of equipment demands/needs within the college.

To request AV Equipment or Support, please complete and submit the following online form.

---

Contact Information
Requester/Contact Person:
UFCD Department/ Organization:	---Select Department--- Clinical Administration Continuing Education Dean's Office Dental Biomaterials Endodontics Facial Pain Foreign Trained Dentists Operative Operative: Public Health & Res Operative: Comm. Based Progs Oral Biology Oral and Max Surgery Oral Medicine Oral & Max: Pathology Oral & Max: Radiology Orthodontics Pediatric Dentistry Periodontology Prosthodontics Quality Assurance Other Other Department/Organization:
Contact Phone:	1) Primary phone 2) Alternative phone
Email:
Type of Support Needed
Event:	Enter the event title, course name and #, or support need.
Event Date(s):	< >Start:  End: Series of events: Mondays Tuesdays Wednesdays Thursdays Fridays Saturday Sundays Please include additional information for a series of events:
Event Time:	Start: Please indicate AM or PM  End: Please indicate AM or PM
Event Location:	(Note: A room must be reserved through the Office of Education, or elsewhere prior to the AV request.)
A/V Equipment Needed :	< > AV Projector 1 - includes a portable LCD projector (user must supply computer) AV Cart 1 - This cart has a Windows computer (ZIP 250 / CD / DVD), VCR, and LCD projector. < > Laptop - Windows system, CD-ROM, Floppy, NO ZIP drive Other Equipment:
A/V Support Needed:	Videotape an event/ Photograph an event/ Other Please include detailed Information about your need for video or photographic support:
Technical Assistance:	Will you need technical assistance during your event? Yes No Please include detailed Information about the type of technical assitance you need:
Responsibility Acknowledgment:	I, or my designee, agree to use all due care and diligence in transporting and operating said equipment. I understand and acknowlege that my department may be charged for repair or replacement, if equipment is damaged or lost through carelessness or negligence. Yes No
Additional Specifications:	Please enter any additional specifications or needs for your event.

 

If you did not find the equipment you needed listed on this page, or if this form does not lend itself to your request, please call Sam Brill at 392-2869 or the Office of Education at 392-2949.

Important Note About Confirmation: Please allow 1-2 business days to receive your confirmation e-mail. After you press the 'Send Reservation Request' button, you will see a confirmation screen indicating that your message has been sent. This message is not confirmation that the equipment is available. We will send the confirmation e-mail to the address you specified above. You are certainly welcome to follow-up by telephone to confirm your reservation if you have any doubts.

---

Faculty & Staff Home | Instructional Support | Resources | A/V Classroom Information | AV Request