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Northwest Area School District Facilities Usage Form
Name of Event
*
Name of Organization
*
Event Start Date
*
+
Event End Date
*
+
Event Setup Time
*
Event Start Time
*
Event End Time
*
Event Coordinator Phone
*
Event Coordinator Email Address
*
Event Location
Event Location
*
Primary School
Intermediate School
Middle\ High School
Ranger Athletic Center
Athletic Field
Area
*
Cafeteria
Kitchen
Classroom
Gymnasium
Auditorium
Library
Playground
Multi-Purpose Stadium
Other
Other
Requested Equipment
Chairs
*
Yes
No
Number of Chairs
Tables
*
Yes
No
Number of Tables
Podium
*
Yes
No
Special Equipment Request Notes
Requested Multimedia
Multi Media Equipment Requested
*
Yes
No
Microphone
*
Yes
No
Number of Microphones
1
2
3
4
Video Projector \ Screen
*
Yes
No
Special Multimedia Notes
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