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Request to Have Video Shown Via Video Broadcast System

 

  
 

Video requested by :_________________________________________  Phone Extension: ___________________

  
     
  Room Number :  ___________________  
     
     
 
  • Please bring this request form with the video you have selected to one of the library staff.  We'll be happy to broadcast your selection for viewing in your room. 
 
 
  • To ensure that the video shown is the correct video, the staff asks that you come to the LMC, and select the video.
  
 
  • Please give at least ONE day's notice.  The staff must have all information no later than 7:00 a.m. the day you wish to show the video in order for your request to accommodated.
  
     
  Specific video title:  _____________________________________________________________________  
  Date(s) to be shown: ____________________________________________  
  Class Periods and times:         
     
 

__1 period @ ___________

  
 

__2 period @ ___________

  
 

__3 period @ ___________                                                        Channel for Viewing:  _________

  
 

__4 period @ ___________     Lunch ________

  
 

__5 period @ ___________

  
 

__6 period @ ___________

  
 

__7 period @ ___________

  
     
  Any other information you feel the library staff should know:  ___________________________  
  _______________________________________________________________________________  
  _______________________________________________________________________________  
     
     
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