Space Request Form Welcome to the UConn Hartford campus. We anticipate this to be a year of fluctuation as we learn about our new facilities and neighborhood. We will make every attempt to accommodate your request in a timely manner. We do reserve the right to determine the appropriate use of all spaces and this request does not guarantee you a space, the space requested or that space is guaranteed. If you have any questions regarding our new space or this process, please feel free to contact: us at email@example.com.This request is for a...*UConn Hartford DepartmentUConn Hartford Student OrganizationUConn DepartmentGeneral PublicPlease note that due to limited space on our campus we may not be able to accommodate your request.Please note that due to limited space on our campus we may not be able to accommodate your request. A Facilities Use Agreement will need to be completed and fees will be incurred for the use of space.Basic InformationName* First Last Student Organization Name*Officer Title*Department Name*Business/Organization Name*UConn Campus Affiliation*StorrsAvery PointWaterburyStamfordUConn Health CenterUConn Law SchoolUConn Campus Affiliation*HartfordStorrsAvery PointWaterburyStamfordUConn Health CenterUConn Law SchoolEmail* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Second Contact Name First Last Second Contact Email Second Contact PhoneFirst Choice Date/TimeDate* Date Format: MM slash DD slash YYYY Start Time* : HH MM AM PM End Time* : HH MM AM PM Occurrence*One TimeWeeklyBi-WeeklyMonthlyEnd Date* Date Format: MM slash DD slash YYYY Second Choice Date/TimeDate Date Format: MM slash DD slash YYYY Start Time : HH MM AM PM End Time : HH MM AM PM OccurrenceOne TimeWeeklyBi-WeeklyMonthlyEnd Date Date Format: MM slash DD slash YYYY Will you need random dates and/or times for the same meeting/program?YesNoProvide the random dates and/or times for the same meeting/program in the space provided below:Will you need extra time in the space for setup/rehearsal/break down?*YesNoPlease explain*Meeting/Event InformationFor requests other than meetings, please answer the questions below to the best of your ability so that we can assist with finding the appropriate space to meet your needs. Please note that a follow up meeting will occur to detail out the event.Event Name*Description - What are you planning on doing?*MeetingSeminarReceptionPurpose*Estimated Attendance*Audience* UConn Students Faculty or Staff General Public Will guests be charged a fee?*YesNoWill there be minors at your event?*YesNoMinors are defined as non-UConn students under the age of 18. University's Minors Protection Policy.Will there be food?*YesNoPlease note you must adhere to the food services policies within each of our Partnered venues and when serving food and beverages to members of the public, you must adhere to City of Hartford's Health and Human Services' Guidelines.Please note - when serving food and beverages to members of the public, you must adhere to City of Hartford's Health and Human Services' Guidelines.Please describe.*CateredTake-OutDeliveryRoom ConfigurationPlease note we may not be able to accommodate you in the venue that you request and fees may be incurred at Partnered venues.Preferred Venue*No PreferenceHartford Times BuildingHartford Public LibraryHartford School of Social WorkRoom Setup*Conference TableLectureClassroomOther specific room setup needs*AV/IT Needs* No equipment needed Projector/Computer Lectern Computer Stations Sound Board Microphones Please note that depending on the venue there may be additional fees associated.Additional NeedsMethod of PaymentKFSCheckNameThis field is for validation purposes and should be left unchanged.