Photo: CIDDE staff members
Go to CIDDE Homepage !
Go to Pitt Homepage!
University of Pittsburgh
 
Text: About CIDDE
Text: News and Events
Text: Support Areas
 Text: Quick Links
Text: Other Links
bullet
bullet
bullet
Non-Print Media Specialist
bullet
 
QUICK LINKS
-
-
 Faculty Workshops
-
-
-
FORMS
-
-
-
-
 
Instructional Media Services Main Page

Media Requisition Form

Please provide all required information and submit the form to request audiovisual equipment and other media materials.  (*Incorrect email address will generate problems when submitting this form.)
For more information, call 648-7240 or send FAX to 648-8812. For assistance email to mediareq@pitt.edu.

Patron Information
Name:
Pitt ID Card#
Telephone Number:
*E-mail Address:
Campus Address:
Department:
Course (Abbr. and Number):
Dept. Account Number:
Service Requested Place orders Monday through Friday between 8:30am and 5:00pm
Equipment setup in classroom by class time (3 business days notice recommended).
 
Date(s) required:
From: AM/PM
 To AM/PM
 
Building:
Room:
Equipment delivered to, and picked up from, a campus office (1 business day notice recommended).
 
Delivery date:
Pickup Date:
 
Building:
Room:
Equipment may be picked up from, and returned to, Instructional Media Services (B-10 Alumni Hall (formerly Masonic Temple)) by patron.
 
 Pickup date:
Return date:
   
Equipment Requested
 Keys for Media Enhanced Classroom  Building    Room #

Qty.

Camera, Video

Qty.

Audio, Projector

Qty.

Computer
Color Monitor Cassette Player/Recorder Portable PC
VHS  Player Screen Portable MAC G3
DVD Player Data/Video Projector Janus
Digital Camera Overhead Projector    
Tripod 16 mm Projector    
Camcorder Speakers    
Please provide blank video tape Microphone    
  I Will provide own video tape Amplifier    

Other
Films/Video Requested (I like to request the following title(s) from the non-print media collections)
I want to order the following media:

Catalog Number

 Title Date of Class
  I will provide my own media.  
Please add any additional information that will help us serve you better.
 
space 1
Center for Instructional Development & Distance Education
4227 Fifth Avenue, Pittsburgh, PA 15260.  412-624-3335
1996-2008 © University of Pittsburgh, CIDDE. All Rights Reserved.
Any questions or comments, please contact CIDDE Webmaster. 07/29/2008