Small Group Room Request Form

Small Group Name*

Leader(s) Name(s)*

Email*

Home Phone

Cell Phone

Day of Group Meetings*

Frequency*

If Other, please explain

Date of First Meeting*

Date of Last Meeting*

Meeting Start Time*

Meeting End Time*

Number of People Expected*

Room(s) Required*

Please check off the room(s) you will need.

Classroom
Multipurpose Room
Kitchen
Other

If Other, please explain

Specify Room Number if You Have a Preference

All efforts will be made to accommodate your request, however, please note rooms are subject to availability and will be assigned on a first-come, first-served basis.

Furniture and Other Items Required

Please specify what you will need for each room and who will be responsible for the set up and tear down of furniture. Please fill out the Room Set Up Schematic.

Round Tables
Rectangular Tables
Chairs

Number of Round Tables Needed

Number of Rectangular Tables Needed

Number of Chairs Needed

Technology Required

Please specify technology needed.

TV and DVD Player
CD Player
Other
Right Now Media Access

If Other, please explain

Miscellaneous

Each Small Group is required to provide their own paper products. Will there be food and/or refreshments during the meeting?

Yes
No

If yes, please indicate the person or persons designated for clean up.

Name of person responsible for locking up of building or area after meeting if applicable.

First Last

*Required Field