ITC Problem/Request Form
EIU College of Education & Professional Studies
Instructional Technology Center(BUZ 1430/1440)
(Pink Sheet)
* Last Name
* First Name
Department
* Email
Phone
Building
Room
Description of Problem/Request
Special Notes
EIU Tag Number(s)
Date Submitted
Time Submitted
Requested Due Date
The following fields are for ITC Staff Use Only (Do not complete)
Referred to
ITC
ITS
CATS
Media Services
Other
Assigned to
Magic Ticket #
Actual Date Completed
Multiplier
Acutual Time Completed
Status
Estimated Completion Time
Priority
Request Taken by
Entered by
ITC Staff Notes
Customer ID