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Office of Information Technology Services

Room Change Request Form

**REQUESTS MUST BE MADE ONE WEEK IN ADVANCE**
**ONE FORM PER REQUEST**

Date:    
Instructor's Name:
last, first 		Department:
Phone Ext:
xxxx		 Alternate Phone#:
xxx-xxx-xxxx
Semester: E-mail:
myemail@isp.com
Course & Section: Class period/ Time:
Assigned Room(s): Class Size:
** Please make your request NO LATER than FIVE business days prior to date needed **
**ONE FORM PER REQUEST**
Start Date For Room Change:


Reason for requested room
change:
Special requirements:
(Subject to availability)