Dublin Integrated Education Center
6805 Bobcat Way | Dublin, Ohio 43016 | 614.793.5634
Today’s Date: 9/10/2015
ROOM REQUEST FORM
CONTACT INFORMATION
Requestor Name
Ohio University Sponsored Event
Yes ☐
No ☐
Company Name/Event Sponsor
Phone Number
Email
EVENT INFORMATION
Event Date
Event Hours
# of Attendees
Type of Event
☐
Meeting
☐
Breakfast/Lunch/Reception
☐
Class/Course
☐
Social Event
☐
Seminar/Workshop
☐
Other
☐
Continuing Education
ROOM CONFIGURATION
How would you like the room configured?
☐
Traditional class (tables and chairs in a row)
☐
Banquet (long tables in a continuous row)
☐
Collaboration class (tables and chairs grouped)
☐
U-shaped
☐
Other
☐
O-shaped
Please describe if “other”
Are additional tables/chairs needed to be set-up in more than one room? (i.e. a
room is needed for a meeting and a separate room is needed for lunch.)
Yes ☐
No ☐
AUDIO VISUAL AND INFORMATION TECHNOLOGY NEEDS
Will you need any equipment for your event?
☐
Polycom (video conferencing)
☐
Smart board
☐
Polycom (phone conferencing)
☐
White board
☐
Document camera
☐
Lecture capture
☐
Projector
☐
Distance learning suite
☐
Computer (desktop only)
☐
Microphone (podium, handheld, lavalier)
Other (please describe):
FOOD AND BEVERAGES
Will you be serving food?
Yes ☐
No ☐
Will you be serving beverages?
Yes ☐
No ☐
Will you be hiring a caterer? Yes ☐ No ☐
Use of a warming kitchen is available for a nominal charge and includes:
coffee maker, ice maker, refrigerator, microwave, warming cabinet, steam table and dishwasher.
Will you or your caterer need access to the warming kitchen?
Yes ☐ No ☐
Please return your completed room request form by email to the Dublin Integrated Education Center
Administrative Specialist, Melody Lynch at lynchm@ohio.edu. If you have questions, Melody can be
reached at 614.793.5634. Upon approval from the Associate Dean, this completed form will be emailed
back to you as confirmation of your reservation.
FOR INTERNAL USE ONLY
Room(s) Assigned
Approved and Date
Confirmation Sent and Date
Operations Manager Notified and Date
Lease/MOU Sent and Date
Associate Dean, College of Health
Sciences and Professions