Facilities Usage Request

School Year(Required)

Date request was made:(Required)

Group requesting use of building:(Required)

Moderator/Contact Person:(Required)

Area of Building Needed:(Required)

Date(s) Needed:(Required)

Time Needed:(Required)

(Please be specific regarding duration of time needed.)

Special Needs: (Podium, Microphone, TV, VCR, etc.)(Required)

Maintenance Personnel Is(Required)

Needed

Not Needed

Start Time(Required)

End Time(Required)

Building Usage Cost(Required)