Audio-Visual Services

Main Desk

SMSU 1 503-725-9100

Instructional Technology Services

Instructor Approval Formclick here for pdf

• This form gives formal instructor approval for an enrolled student to request check-out of audiovisual equipment from Audio-Visual Services Office.
• Instructors must have an active account on file with Audio-Visual Services.
• In Addition, Instructor must:  sign below, include departmental index code (FIS mandatory for coverage of loss, late fees, theft, and/or repair), and campus extension, approving students to check out material for the sole purpose of supporting classroom projects.  The equipment will be checked out under the instructor’s name, who assumes ultimate responsibility for the integrity of the equipment.
• The student also assumes, under the instructor’s authority, that the equipment will be returned in good condition.  All equipment is checked upon pickup, return, or delivery through an operating checklist.  The Student must submit a valid PSU ID upon pickup
• All items are to be checked-out and returned on the same day.  Special circumstances to be determined only by the management.
• All existing Audio-Visual Services policies apply to student check-out of audiovisual media.
• By filling out and signing this form indicates acceptance of these policies stated above.

Today’s Date: ______________________

Student’s Name (print):____________________________________________________

Student’s Signature: _______________________________________________________

Student’s Home Phone: _______________________________

Location: ___________________________   Date Needed: _______________________

Checkout Time:______________________    Return Time: _______________________

Instructor’s Name (print) __________________________________________________

Instructor’s Signature: ______________________________________ Ext:  __________

INDEX CODE: ____________