Requisition #:
Specialized Equipment Request Form
Rev 2014-03-10r01
Request Date: Bldg./Dept.:
Requestor Name: Manager Approval:
Requestor Ext: Manager Email:
Requestor Email: DIT CIO/VP/AVP Approval:
** To request any non-standard equipment (i.e. computer, monitor, laptop, and tablet or Apple products) as well as equipment which is
not required per Department Head (Dean/Chair/Director, etc.), please identify your proposed modifications to the standard configuration
and provide a justification for the request.
Note: Please attach details for your specialized equipment to this form at submission time.
Date Approved: DIT Staff Approval Signature:
Date Approved: DIT CIO/VP/AVP Signature:
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For Internal Use Only:
If not approved, please explain below and advise requestor and approving manager:
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