PORTABLE SMART CLASSROOM UNIT
RESERVATION AND QUESTIONNAIRE FORM

 

A full Portable Smart Classroom Unit may be checked out by an instructor for the entire
semester so that relevant datasets, lectures, etc., may be loaded.

POLICY NOTES
• This service is restricted to teaching faculty for classroom use.
• Training on the proper use of the Portable Smart Classroom components is
REQUIRED before a unit will be released to you.
• Three weeks notice REQUIRED for configuration of the unit.

PLEASE ANSWER THE FOLLOWING QUESTIONS COMPLETELY.

Semester Required:

Spring

Summer

Fall

Year:

Is this a renewal:
Yes
No

INFORMATION REQUIRED ABOUT YOU AND YOUR CLASS(ES)

Name:

Department:

Office Room Number:

E-Mail:

Phone:

Fax:

Will you need Internet access in your office? YES NO
Yes
No

The class(es) in which the Portable Smart Classroom Units will be used, (please note that not
all classrooms have connections for Ethernet available):

_________________________________________________________________________________

Course Number

Building

Room no.

Number of students enrolled

Internet access required
Yes
No
_________________________________________________________________________________

Course Number

Building

Room no.

Number of students enrolled

Internet access required
Yes
No
_________________________________________________________________________________

Course Number

Building

Room no.

Number of students enrolled

Internet access required
Yes
No
_________________________________________________________________________________

Course Number

Building

Room no.

Number of students enrolled

Internet access required
Yes
No
_________________________________________________________________________________

I WANT TO RESERVE A PORTABLE CLASSROOM UNIT with the following projector:

Epson Projector
Toshiba Projector with ELMO

Comments: