Only instructors or USI staff must complete form! Use this form for deliveries in classrooms or conference rooms on USI campus Only. We do not deliver to Offices. Questions? Call 812-465-1080.

* 1. Please type your name.

* 2. What is your complete EMAIL address?

* 3. Please enter a telephone number so we may call you, if we have a question about your request.

* 5. What is your course number or meeting?

* 8. Select equipment needed from the list below. If equipment is not on this list, it may be considered portable equipment and you need to choose that form & pick-up equipment from FA 048.

* 9. Specify below if you need more than one. We DO NOT have any type of computers!
(You may skip this if it does not apply.)

* 11. Is this a semester long loan, for every class?

* 12. If you need equipment 1-5 dates (but NOT entire semester), enter dates below in mm/dd/yy format. For example, if you need equipment on all Tuesdays in October of 2011, you would enter the following: 10/04/11,10/11/11,10/18/11,10/25/11. For semester loans, go to next question.

* 13. During FINALS WEEK, do you need equipment delivered?

* 14. If yes, what is the date and time of your final?

* 15. Select each day(s) you need equipment delivered to your classroom. (For a week-end class, choose Friday for delivery and Monday for pick-up. Please lock the equipment in your office or classroom.)

* 18. Questions? Concerns? Need technical support? Select any that apply from the list below.

PLEASE PRINT A COPY of this completed form for your records and review it before continuing.