Videotape Request Form

First Name*:
Last Name*:
Phone*:
Email*:
Department*:
Course*:
Quarters for which you are a TA: Fall Winter Spring Summer

Appointment To Be Videotaped

First Choice

 
Date:
Day of the Week:
Time:
Building:
Room #:

Second Choice

 
No Second Choice
Date:
Day of the Week:
Time:
Building:
Room #:

Third Choice

 
No Third Choice
Date:
Day of the Week:
Time:
Building:
Room #:
Before submitting your request, please check to make sure you filled out all the required fields. Thank you!