Academic Computing Facilities

Please complete all sections seven days prior to the class start date.

Please choose a Location:

*Center or Program:

*Contact Person:

*Phone Number:

*Email Address:

PLEASE READ: For On-Campus Audio/Visual requests, please email avrequest@nova.edu, or call Chip Yowell at ext. 4921.

Please complete this form and process through your program representative (i.e. site coordinator, assistant site coordinator). Your program representative will process your request through the site technology specialist.

Section A - Information:

Course Number:

Course Title:

Instructor:

Phone:

Email:

Days Requested:

Number of Sessions:

Begin Date:

End Date:

Begin Time:

End Time:

Number of Participants:

ADA / Special Needs:

Special Instructions or Comments: Please indicate a Computer Lab Site or Campus preference. We will do our best to place your class in this location; however, we cannot guarantee availability.

Comments:

Section B - Equipment Requested

Select Equipment:

Other Equipment: