GSRC Commons Room Request Form

Instructions:

1. Fill out the request form completely.
2. Submit this form to GSRC Coordinator in B11 Student Activities Center or email form to cwilson@soanet.ucla.edu

Requesting Staff/Student: ______________________________________________

Phone: ____________________________________

Email: _____________________________________

Name of Activity: _____________________________________________________

Requesting Group: __________________________________________

Program/Activity Description: __________________________________________

Group Size: _______________________________________

Time (start to end): _________________________________

Day(s) Requested: _____________________________________________________

Date(s) Requested: _____________________________________________________

(for a multiple day request, please give date ranges that correspond with days above (i.e. Jan.1 - Feb. 1)

For Office Use Only:

Date

Approved/Declined: