Faculty and Staff Event Request Form

Roosevelt HouseFaculty and Staff Event Request Form

Confirmation of use of space at Roosevelt House is based on scheduling availability, as well as department chair and dean approval when applicable.

Name Name First Last
Department
Email
Phone Phone - ### - ### ####
Requested Dates
Requested Time: (5 hour minimum block, inclusive of setup + breakdown)
Event Type
Rooms Requesting

Rooms Requesting Four Freedoms Room - receptions, lunches, and networking engagements Auditorium - fireside chats, panel discussions, and small conventions Classrooms - meetings, lunches I am unfamiliar with the space, please recommend us a space based on this form
Event Title
Event Description
Guest Count

Max capacities
Auditorium: 105
Four Freedoms Room: 70 (48 seated)
Four Freedoms Room + West Parlor: 105
Second Floor Classroom: 30
Other: Please explain
Panel/Keynote speakers
Is this event open to the public?
Are tickets being sold for this event
Price per ticket $ Dollars . Cents
Are you having a reception that will have alcohol service? Please note a bartender is needed if alcohol is served.
Day of Event Point of Contact - Who on your staff will be working your event?

Faculty Events must staff the duration of the booking including deliveries, set up, check in, auditorium ushering, breakdown, etc.
Additional files if applicable- Event Proposal, Run of Show, Conference timeline, invitation, QR code to registration page, exc.

Maximum file size: 3MB.

Attach Files
All requests are subject to review by Roosevelt House, as well as the requesting departments chair, and Requesting Department's Dean. I acknowledge that the event reservation request is not a reservation confirmation.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.