Revised September 2019
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Antelope
Valley
College
r a.m.
r p.m.
RESERVATION REQUEST
For Ofce Use Only
Signature of Requester
661.722-6451 Fax 661.722-6452
Dry Erase Easel
Small
Large
Document Camera
Portable LCD
Portable Screen
Overhead Projector
Other
Equipment
AVC Number
Smart Cart (PC)
Smart Cart (Mac)
PC Laptop (available soon)
Mac Laptop (available soon)
VCR
Television
Display Easel
How many?
Equipment
AVC Number
Date of request Print name of requester Ext/Phone #
Time needed Date needed Department/Division
to
r a.m.
r p.m.
Media Title Accession Number
I hereby acknowledge that I will be held responsible for damage or unnecessary abuse of school equipment or media resulting from the use of
said items. I agree to abide by and enforce the rules and regulations of the Antelope Valley Community College District governing the use of
equipment and media.