Room Reservation Request

Email address
Name
Status at the University
Your department
Course number
Intended use of room	Media screening Computer use Neither
Date(s) and time(s) requested
Room number, if known Room descriptions
If you are reserving this room for a class, do you wish to reserve a video(s) for the showing(s) ? (note: we do not start tapes)	Yes No
Please list the video call numbers and the show dates (if more than one date)
Do you anticipate needing help with the equipment?	Yes No
Describe your room needs: how many seats do you need; what kind of media are you planning to show/use; do you have any special equipment requests?

University of Virginia Library
PO Box 400113, Charlottesville, VA 22904-4113
ph: (434) 924-3021, fax: (434) 924-1431, library@virginia.edu