CHHS Klehm Hall Room Request Form

This form is to submit room requests for ONLY College of Health and Human Services spaces in Klehm Hall.

KEEP IN MIND:
Official scheduling must be done by Campus Scheduling or Academic Scheduling. You will be instructed on how to complete the process upon approval.

Name: (Request must be made by a University employee) Name: (Request must be made by a University employee) * First Last

University Email: *

Please describe the purpose for this request? (Include an event title, class number and title, or other information essential to your request) *

Date Requested (1) Date Requested (1) * / MM / DD YYYY

Time block (1) *

If necessary, list any additional dates and time block information needed for this request below.

Indicate additional date and time block information below related to the original purpose.

Date Requested (2) Date Requested (2) / MM / DD YYYY

Time block (2)

Date Requested (3) Date Requested (3) / MM / DD YYYY

Time block (3)

Date Requested (4) Date Requested (4) / MM / DD YYYY

Time block (4)

Date Requested (5) Date Requested (5) / MM / DD YYYY

Time block (5)

List important details related to this request here (You can also add additional dates not previously identified): *

Estimated number of people attending this event, program, meeting, etc. *

Select three rooms in order of preference.

(Some rooms have use restrictions)

First Choice: *

Second Choice:

Third Choice: