Loaner Equipment Request Form

Full Name:

Phone:

E-mail:

Pick-up Date:
Month January February March April May June July August September October November December / / Year 2026 2027

Pick-Up Time:
AM PM

Return Date:
Month January February March April May June July August September October November December / / Year 2026 2027

Return Time:
AM PM

Equipment Requested:

Projector

PowerPoint Remote

Laptop

Laptop DVD

Mobile WiFi

Speakers

Equipment Cart

70" Portable Display (stored in Providence conference room, but can be moved)

42 " Portable Display

Tech Assistance Requested

If more than one item is needed from the above list please state what will be required in the comment section below.
If a projector is being requested please list what room (or offsite) it will be used in for scheduling purposes so the correct projector can be assigned: