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Facilities & Grounds Use Request Form for Non-Instructional, Internal Groups

   Contact Information: 
Organization/Group Name  
Contact Name   (e.g. John Doe)
Telephone/Ext   (e.g. 5555 or (765) 966-2656)

   Reservation Information: 
Date(s) Requested   (e.g. 01/01/2006, 01/02/2006)
Time(s) Requested   To
Site  
Room Preference  
Description of Activity
Estimated Attendance  
Will refreshments be served during this event?   Yes
No

   Requestor Information: 
Requested By   (e.g. John Doe)
Today's Date  

     Changing Lives   
Richmond Campus
2357 Chester Blvd.
Richmond, IN 47374
765-966-2656
800-659-4562
FAX 765-962-8741		 Connersville Campus
717 West 21st Street
Connersville, IN 47331
765-825-9394
FAX 765-825-4516
© 2007 Ivy Tech Community College of Indiana
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