Room Reservation Form for the Quad Cities Campus - Quad Cities Campus - Western Illinois University

Please fill information in each field. Use the "tab" key to move to each field.

ALL fields must contain information. You will encounter an error upon submission if a field is left blank.

Meeting Purpose or Title:

Today's Date:
(Example: January 1, 2013)

Requested by:

Phone Number:

Phone Extension (if applicable otherwise type "none"):

Department, College or Organization:

Email address of person who should receive reservation confirmation:

Date of usage:
(Example: January 1, 2013)

Day of the week:
(Example: Monday)

Start Time:

End Time:

Building [select one]: 60th Street Riverfront

Type of room needed [select one]: Video Conference Meeting (no video conference) Computer Lab

Preferred Room (if none type "none"):

Type of room setup [select one]: Arm Chair Desks Tables and Chairs No Preference

Number of People:

If Video Conference, what Macomb building or room will connection be with:
(type "none" if not applicable)

Your Email Address:
Please note: Your email MUST be valid if you require a response.

Any special set-up needed or other additional info that support staff should be aware of:
(type "none" if not applicable)

Western Illinois University - Quad Cities - Academics