AV Equipment Request Form

Mookini Library & Staff / Library Collections /Library Services /Library Policies

The library offers a wide range of Audiovisual Equipment to faculty and staff. There is a minimum 4-day advance notice required.

Please fill out the following form to request a loan of AV equipment. Please call 974-7344 if you have any questions.

Name *
Campus	UHH HawCC Conf. Center
Div/Dept/Program *
Ext. *	Phone
Email *
Additional Info
Date(s) Needed *	from -- mm/dd/yy to -- mm/dd/yy
Time Needed *
* Required field -- All required fields must be filled in or form will not be submitted.

Minimum 4-day advance notice required.

Select pick-up method:

Will pick up from Library Circulation Desk during library hours.
Deliver to: (only available M-F, 8:00am-4:00pm on the UHH Upper Campus.)

Building Room
at time on date -- mm/dd/yy

Select method of return:

Will return to Circulation Desk during library hours.
Request pick up by AV staff (only available M-F, 8:00am-4:00pm on UHH Upper Campus.)

at time on date -- mm/dd/yy

Training on the proper use of the equipment to be loaned is requested: yes no

Equipment requested:

Qty	Type of Equipment	Qty	Type of Equipment
	Cart		PA System
	Cassette Recorder		Projection Screen
	Extension Cord		Podium with University Seal
	LCD Projector		Podium without University Seal
	Microphone with Cable		TV with: DVD
	Microphone Stand: Floor		TV with: VHS
	Microphone Stand: Table
	Overhead Projector		Other:

You will receive confirmation of your request by telephone or email. If you do not receive a confirmation within 2 working days, please call 974-7576.

Select one of the following:

[ ] I received basic training on using the above item(s) properly.

[ ] I chose to forego receiving basic training on using the above item(s) properly.

To be completed when equipment is received:

[ ] I received the items listed above in good condition on __________________.

[ ] I accept full financial responsibility for any damage and/or loss of the equipment listed above, including any repair or replacement costs incurred.

______________________________
Signature Date

AV EQUIPMENT REQUEST FORM