Adult Literacy @ NPL Mobile Lab Request Form
Use this form to reserve the Adult Literacy @ NPL Mobile Lab*. Please fill out as much information as possible to help us better serve you!

*The Mobile Lab includes 10 laptop computers, power cords, mice, extension cords, wi-fi hotspot, and optional headphones.

Your name: *
Your answer
Your email address: *
Your answer
Your phone number: *
Your answer
What workshop would you like us to teach using the mobile lab? Check all the apply. *
Required
If you are not requesting a workshop, for what event or purpose will you be using the mobile lab?
Your answer
The address where the lab will be delivered: *
Your answer
For what date and time would you like to reserve the mobile lab? *
MM
/
DD
/
YYYY
Time
:
How long is the session? *
Hrs
:
Min
:
Sec
What is the earliest time that we can deliver the mobile lab? *
*The larger the window you provide for delivery, the more likely it is that the delivery team can accomodate your specific date and time request.
Time
:
Please list any additional days and times you would like to use the lab below. Please note if earliest possible delivery time is different than noted above.
Your answer
Primary contact name for Mobile Lab delivery: *
Your answer
Primary contact phone number: *
Your answer
Secondary contact name: *
Your answer
Secondary contact phone number: *
Your answer
Where should the delivery truck park? Please note that the truck is 15 ft long. *
Your answer
Is there a handicap entrance? *
If this is a multi-story building, on what floor and in what room will the class be held ?
Your answer
If this is a multi-story building, any special instructions regarding the elevator (employee only elevator, patron elevator, or back of building elevator):
Your answer
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