Equipment and Connectivity Report Form
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Equipment and Connectivity Report Form
Equipment and Connectivity Reporting Form
Submitter Information
*
First Name
*
Last Name
*
Email address
*
Telephone: (e.g. XXX-XXX-XXXX)
*
Position/Title
*
Education Entity:
*
Projected Install Date: (e.g. mm/dd/yyyy)
*
= Required Fields
Equipment Information
Type of Device
Manufacturer of Device:
Model Number of Device:
Purpose of Device:
Connectivity Information
Bandwidth Change (Mbps):
Telecom Provider Change:
Comments
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