1.	Name of Organization:*

2.	Person responsible for arrangements:*
	First Name:   Last Name:   Date Needed:   Phone Number:

3.	Your Email:*

4.	What area of the building are you requesting?*
	Elem: School Gym    Elem: Art Room    Elem:Cafeteria    High: School Gym    High: Cafeteria    Other, please specify

5.	What date are you requesting the building:*
	mm/dd/yyyy

6.	What type of activity will take place? (Dance, Mtg, Banquet, etc)*

7.	Start Time:*

8.	End Time:*

9.	Set up by technology, custodial, and or cafeteria staff(if needed)*
	--Please Select--Yes No

10.	If you selected that you need technology, custodial, and or cafeteria staff please list what you need.

11.	Security Required:*
	--Please Select--Yes No

12.	If you requested security how many will you need: (99,999,999)

13.	Rental or staffing fee to be paid:*
	--Please Select--Yes No

14.	Signature- Organization repersentative:* Please type your name.