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Recreation Services: Facility Request Form

* Required fields

*Person Requesting Facility Space:

*Sponsoring Organization/Department:

*Street Address:

*City:

*State:

*Zip Code:

*Requestor's Affiliation:

Member of FSC:
Student
Faculty
Staff
Member of FSC:
Ward 5B Resident
Outside Group, Specify:

*Home Phone:

*Work/Emergency Phone:

Fax:

*Email:

*Title of Event and Description
(in 50 words or less):

*Date(s) of Event:

*Time(s) of Event
(allow appropriate time for event set-up/break down):

Facility Space Needed:

Basketball	# of courts (up to 3)
Pool	Half Full
Racquetball	# of courts (up to 2)

Dance Studio
Indoor Track
Fitness Center

Special Needs/Equipment:

Please note: This is not an official contract. A member of the Recreation Services department will contact you regarding your request within 5 working days.