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   1050 TEL Building Email: lts@yorku.ca Phone: (416) 736-2100 Ext 55800

Personal Response System (Clicker) Request Form

Online at http://www.fsc.yorku.ca/services/forms/clicker.php

Read Before You Proceed
If you have decided to fully integrate clickers into your curriculum on a regular basis, please complete and submit the request form. This will enable us to make the devices available for student purchase. If you are a STUDENT who would like to purchase a clicker, please go to http://www.yorku.ca/prs/students/purchase.htm to place an order.
Note: Fields marked with * are required.
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I. Requestor Information  
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Email: Your York email address allows us to verify your faculty or graduate student status. If you provide a non-York email, additional information will be required before your request can be processed.

If you are requesting this service for someone else, he/she will be asked to verify your request before it can be processed.
*
* (York Email Preferred)
*
*Are you requesting this service on behalf of someone else?
 If yes, fill out the additional fields below about this person:
 *
 *
(York Email Preferred)
 *
     
II. Course Information  
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Section(s): the section(s) for which you wish to have a clicker set.

Tutorial(s): the tutorial(s) for which you wish to have a click set.
* (e.g. SOSC1010)
*
*
*Term         
*Academic Year
*Number of Students
*Classroom Location
     
III. Clicker Requirements   
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Presenter's Computer: The machine you will be using to present when you use the clickers in the classroom.
*Presenter's Computer

     
IV. Training  
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Provide any additional information related to this service request.
     
 
LTS Learning Technology Services     1050 TEL Building     Email: lts@yorku.ca     Phone: (416) 736-2100 x30077