Facilities Rental Request

External Program Rental Request
Group Name
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Group Contact Person

First NameLast Name
Contact Email
Contact Phone #

Area CodePhone Number
Start Date

MonthDayYear
End Date

MonthDayYear
Day (s) of the week
Start Time

Hour Minutes

AM/PM Option
End Time

Hour Minutes

AM/PM Option
Additional days and/or spaces
If looking for specific dates, you may provide them here.
Location requested
If Other, please describe location requested.
Number of Attendees
Parking (check all that apply)

Other
Campus Safety Needs
(parking, extra officer, room unlocked/locked)
Room Set-Up
Please provide the number of chairs, tables, etc. and requested set-up.
Should be Empty: