Facilities | Department of Telecommunications | Indiana University Bloomington

Dept. of Telecommunicaitons Special Request Form
All fields must be completed. Requests need to be made Three (3) Business Days in advance. Lab Business Days are defined as Monday through Friday. Requests made less than Three (3) Business Days in advance will not be approved. This form does not guarentee approval of use, or the reservation of the equipment specified. All Users of Equipment from the Dept. of Telecommunications are bound by the Policies of the Production Lab.

UID:		Your 10-Digit University ID is Required.
First Name:		Last Name:
Phone:	() -	Email:


When would you like to check the equipment out?		Date: / /
When would you like to check the equipment out?
		:

When would you like to return the equipment?		Date: / /
When would you like to return the equipment?
		:

Please list the equipment you wish to use (be specific):



Please Explain your project. IF THIS IF FOR A CLASS, LIST THE CLASS NUMBER! Try to be as detailed as possible.



I understand that, if granted approval, I will be bound by the Policies of the Production Lab, including full financial responsibility for any equipment I have checked out. I also understand that falsification of any information on the form will immediately void the request, and my be considered Academic Misconduct.

Radio-TV Center 157 | 812-855-5096 | prodlab@indiana.edu