190 High St. Request Form

190 High Street Room Request Form

Please complete this form if you would like to request space for your student group in 190 High St.

Today’s Date (MM/DD/YYYY):

Student’s Name:

WesID:

Telephone Number (123-123-1234):

Email:

Student Group Information

Student Group:

Group Account Number (3 digits):

Group Email (if applicable):

What is your group’s purpose/mission?

How will access to this office better allow you to fulfill this mission (Specifics Appreciated)?

Room Requested:

Estimated number of people who will need access to this facility:

Names and WesIDs of all members of your group who will need access to the space