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Requestor’s Name

Contact Phone
Alternate Phone
Campus Address
Email Address
Event Title
Expected Attendance
Reservation Date
Time In
Time Out

I certify that I am a DSU Faculty/Staff member or a person approved by request for the use of the DSU College of Education Center for Teaching and Learning. I agree to be personally responsible and liable for the welfare and safety of equipment and facilities used in conjunction with this request. I furthermore accept full responsibility for any copyright/trademark violations and misuse of resources and/or facilities.  I also agree that I am solely responsible for the content of produced, broadcast, or duplicated media and waive all claims on the OIT Media Services staff or Ellucian employees.