Departments - Application for Use of Student Services Building Meeting Rooms

Name of Requesting Department: Select one... CEC CMHC DoS DDCE OMBUDS OSFS SSBMGMT UHS

Proposed activity (be specific):

Number of people expected:

Room Choices - Please list choices in order of preference. Only one room will be assigned unless multiple rooms are requested in the comments field. Other rooms may be substituted if the preferred rooms are unavailable.

Are you requesting (choose one option only):
weekly semester-long reservations (e.g., every Wednesday from 8/31/05 through 12/7/05)
All other reservations/individual dates
(Don't include Thanksgiving or Spring Break unless you are really going to meet then.)

Proposed dates of reservation (mm/dd/yyyy):
On Date:  On Date:
On Date:  On Date:
On Date:  On Date:
On Date:  On Date:
On Date:

Reservation Times:
From: 01 02 03 04 05 06 07 08 09 10 11 12 : 00 15 30 45 AM PM NOON  Until: 01 02 03 04 05 06 07 08 09 10 11 12 : 00 15 30 45 AM PM NOON

If you need any special equipment, please contact SSB Building Management at 232-2890.

Comments:

Name of Staff Member:

Phone Number:

Email:

You will receive a confirmation from our office when this form is processed.