INSTRUCTOR 
											CLASSROOM CHANGE REQUEST FORM
											

										
											FALL, SPRING & SUMMER COURSES		
							

							

								Please complete all sections of this form.
							

							

								
									
CLASSROOM REQUEST

										
							

							
							

								Instructor:
										
							

							

								Phone:
										 Email: 
										
							

							

								Department:
										
							

							

								Course Rubric: 
										 Number: 
											Section: 
							

							

								Semester:
										 Course Max Limit: 
											Current Enrollment:  
								
							

							

								Do you have a 
											Documented Medical Disability?: 
									
									
							

							

								TECHNOLOGY 
												INFORMATION:
All Classrooms (Basic): Projector 
											screen, overhead projector, VHS playback (with video monitor or projector), and 
											chalkboard. Please do not request this equipment.

										
Laptop Ready Rooms: Network connection at teaching station, 
											computer display, campus cable television, telephone (on-campus calls only), 
											lighting controls, window treatment, power and remote control for slide 
											projector, projected image and chalkboard can be used simultaneously, ELMO.

										
Multimedia Room: Laptop ready equipment plus-PC and MAC 
											installed, Elmo, laser disk player, slide projector, and cassette deck (audio).

										

									
										
							

							

								

											
Technology Requested: (choose one)


													

													

									
										
							

							

								

					
Comments/Information:
       You must indicate why you need/want a room change.
      This information is required for processing.

												

													

									
										
							

							

								The ability to 
										change classroom assignments is based upon availability. Changes may not be 
										possible if the size/type of room requested is not available at your class 
										time.