Central Pool Classrooms Academic Event Scheduling Request Form Use this form to: Request classrooms for short-term academic events (mid-term exams, review sessions, special lectures, departmental meetings) in central pool classrooms. IF FOOD/BEVERAGES WILL BE SERVED AT THIS EVENT OR IF THIS EVENT IS ON A SATURDAY OR SUNDAY DO NOT COMPLETE THIS FORM. COMPLETE THE SPECIAL EVENT RESERVATION FORM. Other Classroom Request Forms: Special Event Reservation Form Classroom Change Request Form All fields in RED must be filled out completely. Incomplete forms will not be accepted. Please provide information about yourself: Your Name Telephone Number Full E-mail Address School / Center / Academic Department If the event is related in any way to a course, you must indicate the subject and course / section numbers below (ex: ECON 002-401). All courses at Penn have both course and section numbers. Subject Code (ex, ECON) Course Number   Section Number - Please provide information about your course or event. Required Seating Capacity Occurs: One Time Event Occurs Weekly On Day(s) of the Week: Monday Tuesday Wednesday Thursday Friday Start Date : Month January February March April May June July August September October November December Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2008 2009 2010 2011 2012 End Date (for weekly events): Month January February March April May June July August September October November December Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2008 2009 2010 2011 2012 Start Time AM PM End Time AM PM Purpose of event (for example: midterm, review session): Required audio-visual equipment: Single 35mm Slide Standard VCR Dual 35mm Slide TriStandard VCR Overhead Projector LaserDisc Player Visual Presenter DVD Player Projection screen Windows PC Dual screens Macintosh Laptop Inputs Single Cassette Portable Video In Dual Cassette Video Projection CD Player Large Display Monitor Wireless Mic Integrated control Podium Mic Addl Mic Inputs Record Player Other Requested Audio Visual Equipment: Please provide information about your location preferences:   Building Room First choice Select One 3808 Walnut Street Annenberg Arch Building Caster Building Chemistry Claire M Fagin Hall Claudia Cohen Hall College Hall DRL Fisher-Bennett Hall Goddard Labs Grad. Education Hayden Hall Jaffe Leidy Lab LRSM McNeil McNeil Ctr for Early Amercian Studies Meyerson Hall Moore Museum Solomon Stiteler Hall Towne Building Williams Hall Writers House Second choice Select One 3808 Walnut Street Annenberg Arch Building Caster Building Chemistry Claire M Fagin Hall Claudia Cohen Hall College Hall DRL Fisher-Bennett Hall Goddard Labs Grad. Education Hayden Hall Jaffe Leidy Lab LRSM McNeil McNeil Ctr for Early Amercian Studies Meyerson Hall Moore Museum Solomon Stiteler Hall Towne Building Williams Hall Writers House Third choice Select One 3808 Walnut Street Annenberg Arch Building Caster Building Chemistry Claire M Fagin Hall Claudia Cohen Hall College Hall DRL Fisher-Bennett Hall Goddard Labs Grad. Education Hayden Hall Jaffe Leidy Lab LRSM McNeil McNeil Ctr for Early Amercian Studies Meyerson Hall Moore Museum Solomon Stiteler Hall Towne Building Williams Hall Writers House You may enter any additional comments below: