Media Request Form

Media equipment is available for the use of Texas Wesleyan University faculty, staff, and students.

To ensure that equipment is delivered to the appropriate location on time, please submit the form two business days prior to the event or class.

Requestor Name:

Event or Class Campus Sponsor: (student requests only)

Requestor Department:

Requestor E-mail:

Requestor Phone:

Date Needed:

Event Start Time:

Event End Time:

Request Equipment Delivery:	Yes* No

*When does the equipment need to be delivered?

Equipment Should be Delivered to:
Building:
Room:

Equipment to be Reserved: List all equipment and accessories (e.g. extensions cords, multi-outlet power strips, etc.) to be reserved:

Provide a Description of the Intended Use: (e.g. The equipment will be used for a PowerPoint presentation.)

Other Information/Comments: