Valparaiso University
Audiovisual and Computer Peripheral Equipment Request

About This Request
Fiscal Year:
Type of Equipment:
Type of Request:
E-mail of requestor
For whom is this equipment requested?
Name:
Department:
Office Location:
Phone:
E-mail:
Network login
Where will equipment be located?
Department Abbr.
Cluster (if applicable)
Station Number (if applicable)
Building Abbr.
Room Number
Nuts and Bolts
Source:
Timing:
Fallback: If request is not granted, I would prefer to:
Description:
You are welcome to express preferences; however, it is possible that EIS will not be in a position to support them. In that case, you may either elect EIS-supported alternatives or choose to assume responsibility yourself.
Hardware
Feature Configuration Comments (Explain "Other")
Type
Manufacturer
Common Name
Model

Please describe, explain, etc:

Will old equipment be replaced by this?
(If YES, please fill in REQUIRED items and others if you know them)
VU Tag Number (REQUIRED)
Serial Number (if no VU tag)

Other information, such as IP Address, if applicable (symbolic and numeric), locations, etc.

Comments (Anything else we should know or do?):

This form should mail itself to the Requestor E-Mail Address which you provided above. Please recheck that address.

When you receive the confirmation copy of the form, forward it to your Department Chair (or Director), who will forward it to the Dean (or Vice President), who will forward it to EIS.Office@valpo.edu. These endorsements are required before EIS can honor the request. In addition, further administrative endorsement may be required, particularly if the amount requested from general funds exceeds the amount allocated for the stated purpose.

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Aug 15 2005