A/V/L Request Form


2016 Audio/Video/Laptop Request Form
Updated:  11/16/2016

Please fill out the form below if you have an upcoming event that requires A/V setup (Podium, Microphone, etc).   Before filling out the form, please read the Terms and Conditions below.  Please fill each entry out as completely as possible.  If you are requesting a Laptop as part of this form, please read the Laptop Agreement.  Also, please indicate how many laptops you will need in the "Additional  Comments" section at the end of this form.

Terms & Conditions: Any A/V/L support requests must be made at least (2) days in advance.  When specifying an event start time, DO NOT add any extra "setup" time.  The IT department will automatically add 15-30 minutes for preparation, depending on the complexity of the A/V support request.  Once submitted, the Help Desk will review your information, confirm the availability of equipment, and will contact you with updated information in a timely manner.  If any information about your request happens to change, please contact the Help Desk at x1224 immediately.  Any changes not reported to the Help Desk will not be taken into consideration the day of your event.  We are not responsible for inaccurate information.  We will complete the request based on the information given in the form.

By submitting this form, you confirm that you have read the above Terms & Conditions in full and that you understand all the information that was given.  You understand the time frame requirements and agree that you will contact the Help Desk if any changes occur to your request.


Please enter your full name here.
Please enter the name of the department you are affiliated with.
Please enter the best phone number where you may be reached before or on the day of the event.
If applicable, please enter your campus extension.
Please enter your Bloomfield.edu email address here. If you do not have one, please enter the best email address where you may be reached.
Please enter the full building name for which the A/V Support will be needed on the day of your event.
Please enter the room number for which the A/V Support will be needed on the day of your event.
Please enter the date of the event.
Please enter the complete Start and End time for your event in the following format (XX:XXam - XX:XXpm)
Please enter the name of the presenter here, if different from the requester above.
Please tell us if the Presenter is a guest.
Please let us know if Presenter will be bringing their own device for the presentation.
Please specify if Presenter requires any additional adapters.
Please select any additional equipment you may need for your event.
Please enter description of any additional required equipment if not listed above.