Facility Reservation Form

Email Secondary Email

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CLIENT INFORMATION

Email address *

First name *

Last name *

Address 1 *

Address 2

City *

State *

ZIP Code *

Day Phone *

Affiliation *

Organization Name

(if applicable)

Advisor

(student groups only)

EVENT INFORMATION

Type of Space Requested *

Event Type *

Expected Number of Participants *

Age of Participants

Affiliation of Participants *

Simmons Non-Simmons affiliated

Will food be served? *

Yes No

All food requests must be made directly through the Simmons Catering office.

Will there be media at the event? *

Yes No

All media requests must be made directly through Simmons Technology.

Date of Event *

(1st Choice)

Start and End Time of Event (1st Choice) *

Date of Event (2nd Choice) *

Start and End Time of Event (2nd Choice) *

Additional Comments

PLEASE NOTE – By filling out the form above you are only making a space request. Submission of this form does NOT mean you have an approved reservation. The facility manager will send a written confirmation within 7 days of the request.

* required field

Facilities

Facility Reservation Form

CLIENT INFORMATION

EVENT INFORMATION

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