Building Use Request Form – Burrell College of Osteopathic Medicine Forms

Is this a Burrell College Student Group Request?*

Yes
No

Please use the form found here instead Student Organization Event Request Form Thank you!

Event Name*

Type of Event*

Event Description*

Contact Name*

First Last

Contact Email*

Contact Phone Number*

Contact Organization/Sponsor*

Event Date*

Event Start Time*

:

Event End Time*

:

Will this event have a guest speaker from outside of Burrell College?

Yes
No

To accompany the event request, a guest speaker request form must be filled out for approval and submitted to the Office of Student Affairs. You may continue to complete the Student Organization Event request form.

Estimated Number of Attendees*

Expected Attendees*

Select All that Apply (Ctrl Click to Highlight Multiple)

Other Attendees

Where will this event take place?

Burrell College Campus
Off-Campus

Where will this event take place?*

New Mexico Burrell Campus
Florida Burrell Campus

NM Room Requested*

Select All that Apply

FL Room Requested*

Select All that Apply

213 (12 Max)
247 (28 Max – Can be combined with 248 for a total of 56 with partition door open)
248 – (28 Max – Can be combined with 248 for a total of 56 with partition door open)
249 (32 Max)
313 (12 Max)
338 (56 Max – not furnished till late October, early November)
Other

Other:*

This field is hidden when viewing the form

Rooms Requested*

Select All that Apply (Ctrl Click to Highlight Multiple)

Room Configuration Requested*

Setup

If additional time is required for event set up and tear-down, please fill out the following.

Setup Start Time

:

Setup End Time

:

Special Requests/Requirements/Other Needs (e.g. PR needs)

Will Refreshments be Served?*

Yes
No

Audio Visual IT Support Requests

All Burrell College meeting rooms have at a minimum a large format TV monitor with a wireless connection system which will accommodate most presenter laptops. While this system is suitable for most presentations – it may not support high definition video. Additional support / capabilities are available if needed. Please describe any additional requirements below. If presenter is using a Mac, some additional support may be required, so please indicate that as well.

Would you like your event advertised on digital tv signage?

Yes
No

Do you have your own Digital Signage image to submit, or would you like one to be created for you?

Submit
Created

Please include the details (Time, Date, Contact Information, etc) you would like featured on the Digital Signage:

Digital Signage Submissions:

Drop files here or

Accepted file types: jpg, pdf, png, gif, psd, aippt, Max. file size: 8 MB.

Image must a ratio of 16:9, and a resolution of either 1280×720 or 1920×1080. If you have the working file, please submit that, Burrell College reserves the right to make changes to the submitted file .

Not Applicable (Please explain in Setup section)
Any Lecture Hall (200 Max)
Any Seminar Room (25-50 Max)
Any Conference Room (4-12 Max)
Room 111 (Small Conference Room)
Room 112 (Large Conference Room)
Room 128 (Large Conference Room)
Room 147 (Bear Den)
Room 151 (Seminar Room)
Room 152 (Seminar Room)
Room 153 (Seminar Room)
Room 154 (Student Lounge)
Room 155 (Seminar Room)
Room 156 (Seminar Room)
Room 157 (Seminar Room)
Room 158 (Year 2 Lecture Hall)
Room 160 (Year 1 Lecture Hall)
Room 204 (Seminar Room)
Room 306 (Board Room)
Outdoor Space (Courtyard)