Information Arcade ® - Classroom Reservation Request Form

Information Arcade® - Classroom Reservation Request Form

Please contact Annadora Khan (annadora-khan@uiowa.edu) or phone (319.335.5447) if you have any questions about or problems with this form.

NOTE: The fields marked with a '*' are Required Fields. Your form will not be processed if these fields are left blank. If a Required Field is not applicable to you, please enter "N/A".

Did you check availability for the date and time of your anticipated session(s) by checking the calendar?

Instructor Name*:
Phone*:
E-mail*:	Note: If you are submitting a request on behalf of someone, please type YOUR e-mail address.
Campus Address*:
College*:
Department*:

Course or Session Title*:
Course Number*:
Semester & year*:
Number of attendees anticipated:
Attendee Categories (check all that apply):	Undergraduate Students Graduate Students Staff Faculty Other
Classroom Preference (or Conference Room)

Description of session/course and how it will use Arcade facilities: (Please include descriptive information about how the electronic classrooms' hands-on capabilities will be used. This is a key factor for securing approval.) Dates and Times to request* You may request a particular time slot for an entire semester, a single session, or periodic sessions. Entire semester: If you want a particular time slot(s) every week for an entire semester please check the appropriate boxes. Monday Tuesday Wednesday Thursday Friday Time from: Time To: Notes/exceptions: A single session or periodic sessions: Date: Time From: Time To: Add another date... Date: Time From: Time To: Add another date... Date: Time From: Time To: Add another date... Date: Time From: Time To: Add another date... Date: Time From: Time To: Add another date... Date: Time From: Time To: Add another date... Date: Time From: Time To: Add another date... Date: Time From: Time To: Add another date... Date: Time From: Time To: Add another date... Date: Time From: Time To: