Facilities Request Form

REQUESTOR INFORMATION

Today’s Date:
Requestor:
E-mail:
UWL Address:
Local Address:
Office Phone:
Home Phone:

ROOM, GROUNDS, OR FACILITIES REQUESTED

Mitchell Hall

Room 22	Room 26	Room 101
101B Wrestling Room	103A Dance Studio	Room 104 – Pool
Room 119	Room 120	Room 121
Room 163 Fieldhouse	Gym 112	Gym 113
Gym 114	Climbing Wall	Indoor Ropes Area

Which item (or items) from the Mitchell Hall list above would you like to reserve for your event?

Outdoor Facilities/Grounds

Stadium	Track & Field	Hall of Honor
Reception Suite	North Campus Rm	Varsity Soccer Field
Sportfield #2	Sportfield #3	Sportfield #4
Sportfield #5	Baseball Field	Softball Field
Tennis Court 1-4	Tennis Court 5-8	Tennis Court 9-12
Tennis Court 13-16	Rec Field #1	Rec Field #2

Which item (or items) from the Outdoor Facilities/Grounds list above would you like to reserve for your event?

Wittich Hall

Room 9	Room 104	Room 111
Room 116-Pool	Gym 201	Gym 203
Walking Track

Which item (or items) from the Wittich Hall list above would you like to reserve for your event?

EVENT INFORMATION

Name of Event:
Date of Event:
Sponsor/Department/College:
Faculty Representative:
Office Phone:

Will there be an admission charge? Yes No

Will non-university students participate? Yes No

Set-up Time: Start Time: End Time:

SUBMITTING YOUR REQUEST

By clicking the "Submit" button below, the users, sponsoring group, and representatives agree to adhere to all rules, regulations, and accept liability during use of this state owned facility.