What is the nature of your request?		I am scheduled to teach this course
		This is a special request to use the room
Course number or name of special class/workshop:
For which quarter?
		Spring 2010
		Summer 2010
		Fall 2010
		Winter 2011
		Spring 2011
Dates/days of week needed? (For special class/workshop.)
Meeting times: (Include a.m. or p.m.)	(beginning-ending)
Number of students	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Your Name:
Department:
Work Phone:
Home Phone:
e-Mail Address:
Comments or other information:
Red = Required Information