University of Connecticut Waterbury | UConn-Waterbury Faculty and Staff Room Reservation Request Form

Event/Activity Reservation Request

Department Name:*

Contact Name:*

First Last

Email:*

Phone Number:*

Will you be in attendance?*

Yes
No

Responsible Party Contact Name:*

First Last

If you will not be in attendance, please provide contact information for responsible party in attendance.

Email:*

Phone:*

First Choice Event Details

Start Date of Event/Activity:*

End Date of Event/Activity:*

Occurrence:*

One-Time
Weekly
Other

Actual Event Start Time:*

:

Actual Event End Time:*

:

Set-Up Start Time:

:

Clean-Up End Time:

:

Please describe "other" occurrence (include event dates, event start and end time & event set-up and clean-up time)

Would you like to provide a second choice option if your first choice cannot be accommodated?*

Yes
No

Start Date of Event/Activity:*

End Date of Event/Activity:*

Occurrence:*

One-Time
Weekly
Other

Please describe "other" occurrence:*

Actual Event Start Time:*

:

Actual Event End Time:*

:

Set-Up Start Time:

:

Clean-Up End Time:

:

General Description of Event

Event/Activity Name:*

Event Type (check all that apply):*

Meeting
Lecture/Talk
Conference
Seminar
Reception
Review Session
Exam or Make-Up Exam
Computer Session for UConn Waterbury Class
Other

Please describe "other" event type:*

Describe the event including the purpose of the request (i.e. fundraiser, public meeting, class, etc.):*

Who will be attending this event/progam(check all that apply)?*

Organization Members
UConn Staff/Faculty
UConn Students
General Public
Other

Please describe "other" attendees:*

Estimated Attendance:*

Please enter a number from 0 to 225.

Will you be providing food at your event?*

Yes
No

Will you be using a grill, fire, open flame, or sternos?*

Yes
No

Rooms Requested(check all that apply):*

Please select which of the following set-up will be required for your event(check all that apply):*

Auditorium Style Seating
Round Tables
Rectangular Tables
Stage
Podium
Flags
None
Other

Please describe "other" set-up requirements:*

Please select which of the following AV/IT equipment will be required for your event(check all that apply):*

Internet
Microphone
Projector & Screen
None
Other

Please describe "other" AV/IT requirements:*

Will participants be charged a fee to attend?*

Yes
No

Is this a grant funded program?*

Yes
No

Will there be minors at your event?*

Yes
No

Phone

This field is for validation purposes and should be left unchanged.

Waterbury

UConn-Waterbury Faculty and Staff Room Reservation Request Form

UConn-Waterbury Campus Room Request - Faculty and Staff

Event/Activity Reservation Request

First Choice Event Details

General Description of Event