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Winthrop University
College of Education
Instructional Technology Center
Suzanne Sprouse, Director
EDUC 275 & EDUC 602
Special Equipment Request Form
EDUC 275 & EDUC 602 classes receive special preference regarding which items
they will need to have provided for them at the time of each class. Please notify the
ITC staff within 24 hours of scheduled class date to ensure that items in the bins
are charged and ready to be picked up.
Name: ___________________________________
Class Date: _______________________________
Phone Number: ____________________________
Class Time: _______________________________
Please modify bins as necessary by checking each item requested:
Macbooks
_____Quantity per bin
Wii items (please specify):
Macbook power cords
_____Quantity per bin
_________________________________
iMovie handouts
_____Quantity per bin
_________________________________
Firewire Cables
_____Quantity per bin
_________________________________
Camcorders
_____Quantity per bin
_________________________________
Camcorder power cords
_____Quantity per bin
_________________________________
Digital Still Camera
_____Quantity per bin
_________________________________
USB cords
_____Quantity per bin
_________________________________
Tripods
_____Quantity per bin
Other (please specify):
Boom Mics
_____Quantity per bin
_________________________________
Batteries
_____Quantity per bin
_________________________________
Ext. Cord/power strip
_____Quantity per bin
_________________________________
DV tapes (used/new)
_____Quantity per bin
_________________________________
_________________________________
_________________________________
For ITC use only: (please initial and add date/time)
_________________________________
_________________________________
Bins prepared by: _____________________________ _________________________________
Date/Time prepared: __________________________ _________________________________
_________________________________
Bins checked in and put away by: ________________ _________________________________
Date/Time checkin
in:__________________________
_________________________________
Comments:
________________________________
_________________________________
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