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BHCLR Room Request Form 2020
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* Indicates required question
Requestor:
*
Your answer
Date of Request:
*
MM
/
DD
/
YYYY
Room Requested:
*
1131 Conference Room (6)
1200 AB Classroom (80)
1200 CD Classroom (80)
1201 Chemistry Lab
1204 Nursing Skills Lab
1323 Special Testing Office
1402 Microbiology Lab
1404 Conference Room (25)
1405 Histo Classroom (6)
1406 Classroom (50)
1408 RAD SR Classroom (15)
1409 Conference Room (7)
1501 Classroom (90)
1503 A Classroom (10)
1503 B Classroom (10)
1504 Sleep Tech Skills Lab
1505 Classroom (50)
1507 RAD JR Classroom (15)
1511 Surgical Tech Skills Lab
1514 Anatomy & Physiology Lab
1601 A Classroom (75)
1601 B Classroom (75)
1601 C Classroom (75)
1601 D Classroom (75)
1602 AD Classroom (100)
1602 BC Classroom (100)
1603 Anatomy & Physiology Lab
1604 Classroom (25)
1605 Classroom (30)
1606 System Nursing Development Classroom
1607 A Computer Lab (36)
1607 B Computer Lab (36)
1607 C Computer Lab (14)
1609 IS EPIC Training Room
1704 Nursing Skills Lab
IS Training Room 2
Scrub Tech Skills Lab
Training Room 1
Training Room 2
Training Room 3
Date Needed:
*
MM
/
DD
/
YYYY
Start Time:
*
Time
:
AM
PM
End Time:
*
Time
:
AM
PM
Number of people involved:
*
This will help us find an alternative if the room requested is booked.
Your answer
Purpose of room requested:
*
Needed for Medicare room allocation purposes
Your answer
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