Bristol Community College

Bristol Community College

Assistive Technology Lab Request

Your Information:
  First Name*:  
  Last Name*:  
  phone*: ext.  
  Preferred method of contact*: email phone  
  Learning Specialist*:  
  This request is being made by someone other than the person listed above
(If you checked this section, please list your name and relationship to the person listed above in the comments box below)


Event Information :

  Date(s) Needed*:  
  Start Time*:  
  End Time*:  
  Location : * Bldg:  Room:   


Equipment Needed*:


  Windows users:
      Control-click for more items
  Macintosh users:
      Command-click for more items

If "Other" please indicate equipment below under notes