Media Production Request Form

Please fill out all the fields as completely as possible. All information is needed to make sure that Instructional Technology Services
Audio/Visual team gets the event scheduled and has the proper equipment brought to the site for the event. *-required

MPT requires at least 2 weeks notice for all Media Requests. Requests made less than 2 weeks before the event may not be accepted based on staff availability.

*Your Name:
*Email:
*Phone:
*College or Academic Unit:
*Department:
Type of Request:
*Date of Event (MM/DD/YYYY):
*Starting Time:
*Ending Time:
*Campus Location:		(select one)
*Building Name:
*Building Room Number:
*Name of Recording:
*On-site Contact's Name and Cell Phone Number for Event Recording (this is someone at the event):
*Presenter or Presenter's names:
*Title of presentation or panel:
*Will the presenter use a computer during the recording?		Yes No
*Format in which the recording will be shared:
Are you working with an Instructional Designer?		Yes No
Name of the Instructional Designer you are working with:
Special Instructions (If this is a video conference, please provide location and contact at other site. If this is a digitization request, please list all media to be digitized.):
		I have read and accepted the terms and conditions of the Media Production Request & Equipment Loan Policy

Please print and complete a copy of the Consent And Release Form in preparation for your event (note: your event is not approved until you have heard from an ITS representative).

1 E. Jackson, Chicago, IL 60604 | 312.362.8000