1. Organization/Student Name:
2. Cost Center:
3. Submitted by
4. Phone: E-Mail:
5. Date(s) and Time(s) Requested: 
6. If you would like to use a particular room, please specify:
7. Which best describes the purpose for which the classroom is needed? (Please select one)
Meeting  Lecture  Film  Other (describe) 
8. Description - Who and/or what will be presented or discussed at this gathering. Provide as much detail as you can. If you are hosting a speaker or panel, indicate the organizations represented or those with which the speakers are affiliated.

9. Who is eligible to attend? (Select all that apply)
Organization Members  GU Community  Public  Press (Communications, 7-4328)
10. Size of group expected: 
11. Will there be off-campus publicity?  yes  no