Media Request Form

Contact person:
Contact phone:
Contact email:      
Department / Organization:
Name of class / event:
Event date(s):
Day(s) of week:
Start time:
End time:
Will class / event be repeated?
Computer needs:

Internet connection needed:
I need my event recorded:
Description of Media needs:

Comments or suggestions? Please let us know!


** Please note the following **
Educational Media provides portable equipment only when appropriate rooms with installed equipment are not available.
Exceptions can only be made with the approval of the Director of Educational Media.
If a room with installed equipment is not available for the needed use, Media will determine if portable equipment can be provided.

Feel free to contact Educational Media at 497-7900 or mediaservices@ptsem.edu if you have questions or need assistance in determining which rooms or services will best meet your needs.