DEPARTMENT OF ATHLETICS
MULTI-PURPOSE REQUEST FORM

CHECK THE SCHEDULE FOR AVAILABLE TIMES - VIEW SCHEDULE


*Name( required) What is the name of the group?

Status of individual completing form

Phone Number (required) Cell Phone Number (Cell)

Contact Email (required):

Campus Box Number/Street Address

City, State, Zip

Please select the day (s) you would like to use the dance room (Primary)
Sunday: | Monday: | Tuesday: | Wednesday: | Thursday | Friday | Saturday:

Time Requested (1st choice) - Start End

Please select the day (s) you would like to use the dance room (Secondary)

Sunday | Monday | Tuesday | Wednesday | Thursday | Friday | Saturday

Time Requested (2nd choice) - Start End

What is the Starting Date What is the Ending Date

Approximate Number of Participants

Who will be offering/teaching the course

What are the instructors credentials and experience

Do you offer the course elsewhere? If yes (please specify where)

Are you charging for your services? If yes, how much? Is this your normal fee?

If no, what do you charge elsewhere?

Additional Comments

No classes will be scheduled or run in the Kneller Center without approval from the Athletic Department