Before you fill out the Research Space Request form, please review the space descriptions.Primary Contact Information Last Name * First Name * Email * Request Information Communication Faculty Sponsor Name * Supervising Faculty Name (if different than above) Supervising Faculty Department (if not communication) IRB Protocol Number * Number of Seats Needed * Access Granted to Those Listed Below * Name.# | Cell# | Employee ID | ------------------------------------------------------------------------------------------------- Request Type * - Select -Room Only: Comm = 1 week notice, Univ = 2 week noticeRoom + IT Assistance: 3 weeks notice required (computer, printer, camera, etc.)Room + Special Needs: 4-6 weeks required (software purchase/installation, IT assistance) Special Requests Type of Study * - Select -Computer SurveyGaming ResearchMobile Media LabPen/Paper SurveyVideo ViewingOther If other, please describe * Description of Study * Start Date of Study * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20192020202120222023 End Date of Study * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20192020202120222023 Please Select Your Room Preference * - Select -3025 Derby Hall3150 Derby Hall3176 Derby Hall3180 Derby Hall216 Journalism217 Journalism224 Journalism233-1 Journalism233-2 Journalism340 Journalism (Geowall)342 Journalism (Classroom)360 Journalism (Large Audience)381 Journalism (Audience Response) Time Preference InstructionsPlease state your requested days of the week and start and end times, preferred blocks are 8:30 – 1:00 and 1:00 – 5:30. Times and days must be standard across the duration of the reservation (e.g. MWF 8:30 – 1:00). Time Preference * *Please note it is your responsibility to make sure that all equipment is turned off and that the room is securely locked when you are done each day. Leave this field blank CAPTCHAThis question is for testing whether you are a human visitor and to prevent automated spam submissions.