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Application for M-TEC Facility Use
General Information
Name of Organization
*
Address
*
City
*
State
*
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Marianas Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
Contact Person
*
Email
*
Phone
*
Cell
Fax
Event Information
Name of Event
*
Type of Event
*
Meeting
Conference
Training
Community Event
Other
Date(s) Requested
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
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
26
27
28
29
30
31
Year
Year
2022
2023
2024
2025
2026
Type of Organization
*
Profit
Non-Profit
Day(s)
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Start time
*
Hour
Hour
1
2
3
4
5
6
7
8
9
10
11
12
:
Minute
Minute
00
05
10
15
20
25
30
35
40
45
50
55
am
pm
End time
*
Hour
Hour
1
2
3
4
5
6
7
8
9
10
11
12
:
Minute
Minute
00
05
10
15
20
25
30
35
40
45
50
55
am
pm
Number of Attendees
*
Room Information
Room Type
*
- Select -
Conference Room 103, capacity 13-15
Classroom 110, capacity 20-25
Classroom 117, capacity 25
Classrooms 122/126, capacity 60-80
Computer Room 114, capacity 18
Computer Room 118, capacity 16
Computer Room 124, capacity 21
Auditorium 104, capacity 100-120
Please specify room set-up requirements (e.g. chair configuration)
*
Room Needs (Select all that apply)
*
Document Camera (Auditorium)
PowerPoint Presentation
Software Installation (requires 2 week advance notice)
Video Conferencing (Auditorium)
Telephone Conferencing (Room 103)
Flip Chart
Microphone (Room 104, 122, 126, and Auditorium)
Laptop or Laptop Connection (Auditorium)
Wireless Internet Access
Overhead Projector for Transparency
LCD Computer Projector
Additional Notes
Please list any additional notes here
"