Requestor's Name Department Contact Phone Alternate Phone Title/Position Campus Address Email Address Event Title Reservation Date Time In Time Out Comments
I certify that I am a DSU Faculty/Staff member or a person approved by request for the use of the DSU College of Education Center for Teaching and Learning. I agree to be personally responsible and liable for the welfare and safety of equipment and facilities used in conjunction with this request. I furthermore accept full responsibility for any copyright/trademark violations and misuse of resources and/or facilities. I also agree that I am solely responsible for the content of produced, broadcast, or duplicated media and waive all claims on the OIT Media Services staff or Sungard employees.
800-GO-TO-DSU 1003 W. Sunflower Road Cleveland, MS 38733
