Room Request Form Basic InformationRequester Name* First Last Sponsoring Department Name (no acronyms please)* Requester Email* Requester Phone*FOAPAL InformationFund* Org* Program* Host Name (if different from requester) First Last Event LocationChoose a Building* No Preference 195 Farmington Avenue Academic Building, Library Main Building Musculoskeletal Institute Munson Road Outpatient Pavilion Outside Space University Tower 195 Farmington Avenue3rd Floor Conference Room, U3071A3rd Floor Conference Room, U3071B3rd Floor Conference Room, U3071A/U3071BAcademic Building, LibraryAcademic Lobby, AG043Academic Mezzanine, AM020Academic Rotunda Hallway, AAMClassroom A1, AAM002Classroom A2, AAM003Classroom A3, AAM004Classroom A4, AAM005Classroom A5, AAM007Classroom A6, AAM008Classroom A7, AAM009Classroom A8, AAM010Classroom B1, AM030Classroom B2, AM029Classroom B3, AM028Classroom B4, AM027Classroom B5, AM026Classroom B6, AM019Classroom B7, AM018Classroom B8, AM017Classroom B9, AM014Classroom B11, AM014AClassroom B12, AM012AClassroom B13, AM010AClassroom B14, AM013AClassroom B15, AM011AClassroom B16, AM013Classroom B17, AM011Classroom C1, AM043CClassroom C2, AM043BClassroom C3, AM043DClassroom C4, AM043AClassroom C5, AM043EClassroom C6, AM043Classroom C7, AM042Classroom C8, AM042AClassroom C9, AM046AHuman Anatomy Lab, AM006Library Learning Center 1Library Learning Center 2Library Learning Center 3Library T2C2 Room 1Library T2C2 Room 2Massey Auditorium, AG058Prosection Room, AM007Virtual Anatomy Lab, AM008Walker Conference Room, AG070Main BuildingKeller Auditorium, CG099Keller Lobby, CG076Low Learning Center, CG076Main Hospital Lobby, CM185ARB Large Conference Room, EG013ARB Small Conference Room, EG052Café Lobby Table 1, FM015Café Lobby Table 2, FM015Cafeteria (Sections 1-3), FM016Cafeteria (Sections 4-5), FM017Onyiuke Dining Room, FM002Musculoskeletal InstituteMarbles Café/Lobby, N1001Munson RoadMunson Café, P4060Munson Training Room, P4002Outpatient PavilionMain Lobby, S10061st Floor Small Conference Room, S12001st Floor Large Conference Room, S10102nd Floor Small Conference Room, S22002nd Floor Medium Conference Room, S20302nd Floor Large Conference Room, S20103rd Floor Small Conference Room, S32003rd Floor Medium Conference Room, S30303rd Floor Large Conference Room, S33014th Floor Medium Conference Room, S45304th Floor Large Conference Room, S45325th Floor Concourse6th Floor Large Conference Room, S63017th Floor Medical Education Center, S7320 A7th Floor Medical Education Center, S7320 B7th Floor Medical Education Center, S7320 C7th Floor Medical Education Center, S7320 A/B/C7th Floor Conference Room West A, S7103 A7th Floor Conference Room West B, S7103 B7th Floor Conference Room West B, S7103 A/BOutside SpaceAcademic DrivewayAcademic EntranceCenter CourtyardAdministrative Services Building (ASB) Driveway400 Farmington AvenueMunson Road DrivewayUniversity TowerMain Floor Mezzanine Space, TMC04Event InformationTitle and Description of Event* If in the Academic Building or Library, What Is the Nature of Your Event?Choose one:Clinical Operations/Clinical DepartmentExam (School of Medicine, School of Dental Medicine, Resident, Fellow, Shelf, Certification, etc.)Graduate School Course/EventIT TrainingMedical or Dental Student Group/EventSchool of Dental Medicine Course/EventSchool of Medicine Graduate Medical Education Course/EventSchool of Medicine Undergraduate Medical Education Course/EventOtherAudience, Number of Attendees?Total Number of Attendees for Room Requested*Total Number of Outside, Non-UConn Health Attendees* How Many Parking Spaces for Outside Attendees? (Individuals Who Do Not Have Hang Tags)* Will There Be Food at Your Event? Choose a Caterer*Morrison Catering Order Form Morrison Outside Caterer None Will Alcohol Be Served?*Policy on Alcohol Use at UConn Health Yes No Event Occurrence* One-Time Weekly Bi-Weekly Monthly First Choice Event Date/TimeDate* MM slash DD slash YYYY Start Time* : Hours Minutes AM PM End Time* : Hours Minutes AM PM Second Choice Event Date/TimeDate MM slash DD slash YYYY Start Time : Hours Minutes AM PM End Time : Hours Minutes AM PM If Meetings or Practices Are on Random Dates and Times, Please Submit Them Below:Room ConfigurationRoom Set-Up TypeView Room Setup StylesTheater Style SeatingU-Shape of TablesHerringbone of Tables and ChairsOpen SquareBreakout SessionConference StyleNon-Standard SetupTake Room As IsTotal Number of TablesHow Many of Above Tables Will Be for Food?Number of ChairsComments/Special InstructionsA/V Equipment Needed (Fees May Apply)Check all that apply. No Audio Visual Equipment Projector Podium Microphone Sound System Portable Screen Video Conferencing Other Equipment Needed (Fees May Apply). How Many of Each?EaselExtension CordPower StripCoat RackWaste ContainersSandwich BoardsInstallation of Additional Software for Library T2C2 Rooms Provide the name(s) of software to be used.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.