UConn-Waterbury Faculty and Staff Room Reservation Request Form UConn-Waterbury Campus Room Request - Faculty and Staff This form is ONLY for UConn-Waterbury faculty and staff to request space at UConn-Waterbury. Submission of this form must be 3 weeks in advance of the proposed event/activity date. Submission of this form does not indicate approval of the event/activity or guarantee campus space use. Event/Activity Reservation RequestDepartment 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 DetailsStart Date of Event/Activity:* Date Format: MM slash DD slash YYYY End Date of Event/Activity:* Date Format: MM slash DD slash YYYY Occurrence:* One-Time Weekly Other Please describe "other" occurrence (include event dates, event start and end time & event set-up and clean-up time)Actual Event Start Time:* : HH MM AM PM Actual Event End Time:* : HH MM AM PM Set-Up Start Time: : HH MM AM PM Clean-Up End Time: : HH MM AM PM Would you like to provide a second choice option if your first choice cannot be accommodated?* Yes No Start Date of Event/Activity:* Date Format: MM slash DD slash YYYY End Date of Event/Activity:* Date Format: MM slash DD slash YYYY Occurrence:* One-Time Weekly Other Please describe "other" occurrence:*Actual Event Start Time:* : HH MM AM PM Actual Event End Time:* : HH MM AM PM Set-Up Start Time: : HH MM AM PM Clean-Up End Time: : HH MM AM PM General Description of EventEvent/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):* Multi-Purpose Room ( 113, 116, & 119 ~ 60-225 Individuals) Multi-Purpose Room 113 (60 Individuals) Multi-Purpose Room 116 (60 Individuals) Multi-Purpose Room 119 (60 Individuals) Courtyard (200 Individuals) Lobby (75 Individuals) Classroom (25-95 Individuals) Rectory Event Space (165 Individuals) Computer Lab (16-30 Individuals) Conference Room (20 Individuals) 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