Charlotte Public Schools

CHARLOTTE PUBLIC SCHOOLS

BUILDING/TECHNOLOGY USE REQUEST

Please return to Charlotte Public Schools

Fax: (517) 541-5745 or Email:

Today’s Date:
Contact Person scheduling this class/course/event
Street Address / City / Zip Code
Cell Number / Work Number
Email Address / Fax Number
Course/Class/Event Name
Class Instructor / Number of Participants
Date(s) Requested / Time(s) Requested
Purpose of Building Use
HIGH SCHOOL (CHS): Gym ☐ Lecture Room ☐ Classroom # Cafeteria ☐ Other
Outdoor Field (explain special requests here
MIDDLE SCHOOL (CMS):
Gym ☐ Aux Gym ☐ Activity Room (AR) ☐ Cafeteria ☐ Cafetorium ☐ Planning Room ☐ Conference Room ☐ Media Center ☐ Classroom #
UPPER ELEMENTARY (CUE):
Conference Room ☐ Classroom #
For Gyms, Cafeteria or Cafetorium, & Media Center, use MIDDLE SCHOOL BOX above.
ELEMENTARY SCHOOLS (PARKVIEW AND WASHINGTON):
Parkview Gym ☐ Parkview Media Center ☐ Rotary Park Fields ☐ Parkview Classroom #
Washington Gym ☐ Washington Media Center ☐ Washington Classroom #
COMPUTER LABS:
HS Media Center ☐ HS Career Prep Lab☐ HS Lab 409☐ HS Lab 410☐ HS CAD ☐ HS RM 321☐ HS RM 338☐ HS RM 340☐ HS Classroom # MS RM E110E☐ MS RM E106☐ MS E110D☐ MS E117☒ MS Classroom # PA RM 106☐ PA RM 207☐ WA Lab☐
Hardware Needed: IMB (laptop) ☐ Internet Access☐ CD player☐ Data Projector☐ Video Projector☐ Video Screen☐ Digital Visualizer☐ DVD ☐ Overhead Projector☐ Lectern Microphone☐ Wireless Hand Held Microphone☐ Wireless Lavaliere Microphone ☐ Additional Microphone☐ Audio Assistance System ☐ Cable TV☐ Computer Presentation☐ Mini Disc Player☐ Sound Reinforcement☐ VCR☐ Other
Technology Staff Assistance Needed? Yes ☐ No☐
SPECIAL REQUESTS OR OTHER INFORMATION

WHERE: