Work Order Request - Athens State University
Classroom Technology Incident Report

First Name * Please enter your First Name

Last Name * Please enter your Last Name

E-mail * Please enter email address

Phone Please enter your phone

Location Main Campus

Service Category *

Fill out all forms.

Forms

Priority *

Work Description *

Requested Completion Date *

Attachments

Comments

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Comment 1

Real Person Verification

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LTRC Equipment Loaner Request Form

Please do not use this form to request Audio Visual Services. Use this form when you need to borrow Audio Visual and Computer Equipment for short to long term use.

The following items are generally available for loan. Please note that some items are only available for short term loan.

Items are subject to availability.

* Equipment Requested (Choose all that apply)

Kandao- 360 Degree Webcam
Owl- 360 Degree Webcam
Avaya- Wide angle Webcam
Avermedia Cam 313- Webcam
Snowball Ice- USB Microphone
Revolabs- Wireless Lavalier Mic
Logitech H820e- Bluetooth Headset
USB Keyboard
USB Mouse
Computer Speakers
Qomo QPC-50W - Wireless Document Camera
Aver M70W- Document Camera
Elmo TT-12W- Document Camera
Portable Green Screen
Projector (Short Term Only)
10' Projector Screen (Short Term Only)
Wireless Handheld microphone (Short Term Only)
Portable Speaker w/ Stand (Short Term Only)
Microphone Stand
No Equipment Needed

* Computer Equipment (Choose all that apply)

HP Probook 650- Laptop
Ipad- Tablet (Short Term only)
Meta Quest 2 VR Headset Kit
No Computer Equipment Needed

Any other requests not listed above, or if multiples of an item is needed.

* Type of loan

Short Term (2 weeks or Less)
Mid Term (2-5 weeks)
Semester Loan (Returning at the end of the semester)
Transfer of Ownership (some items are available to faculty for transfer)

If possible, please allow at least 2 business days from request to the date of pick up.

* Date requested for pickup

* Requested Date of Return

Statement of Responsibility

I understand that I am fully responsible for the care of the equipment being loaned to me, and agree to return the equipment, including all its accessories, in the condition in it was loaned.

I accept responsibility for any damage that may occur while under my care. I agree not to loan or assign this equipment to other persons.

I will erase any files that I have loaded or installed on any devices, and understand that any files left on loaned devices will be deleted.

I understand that devices with internal batteries may or may not be fully charged, and accept responsibility to obtain and fully charge these devices in advance of my use.

I agree to return the equipment on or before it's due date, and understand that failure to surrender the equipment may result in being charged its replacement value.

I attest that I will only use this equipment in direct fulfillment of my responsibilities as an Athens State employee.

* Agreement

I agree to the terms listed above
I do not agree to terms above

LTRC use only- No need to fill anything out.

(LTRC USE) Date checked out

(LTRC USE) Loan Return Date

(LTRC USE) Actual Return Date

Vehicle Reservation Form

* Requestor

* Date and time of pick up

* Date and time of return

* Where will you be traveling

* Number of Passengers

* Is Cargo Space needed

Yes
No