Library Informatics Classroom Rental Request Form

The Library Informatics Classroom (E2.310A) on the Main Floor of the South Campus (main) Library is available to groups for a fee. The Library Informatics Classroom holds 18 computers for students and an instructor’s station with a computer and overhead projector. Please see the information page to learn more about the resources available and the room policies. If you have any questions, you may contact us at LibClassroom@utsouthwestern.edu.

Information About You

* Required information
* First Name:
* Last Name:
* Status:	Please Select Faculty Nurse Post Doc/Fellow (PhD) Resident/Fellow (MD) Staff Student-GSBS Student-SHP Student-SWMS Other
* Affiliation:	Please Select Children's Medical Center Parkland Health & Hospital System UT Southwestern Austin Programs UT Southwestern Medical Center UT Southwestern University Hospital - St Paul UT Southwestern University Hospital - Zale Lipshy Other
Department:
* Email:
Phone:
Fax:

Class Information

*Course Name:
*Purpose:
Course Number:
*Class Date:
*Pre-Access Time (preparatory time before the session):
*Actual Start Time:
*Actual End Time:
*Post-Access Time (wrap-up time after the session):
Sponsoring Faculty (if different from the requestor):
*Expected Number of Attendees:
Expected Type of Attendees: (check all that apply)	Faculty Nurses Residents MS1  MS2  MS3  MS4 Graduate School Students School of Health Professions Students Postdocs Research Staff Adminstrative Staff Other Clinical Staff Off-Campus Guests
CE Credit? (check all that apply)	Physician Nursing Pharmacy Other
*Registration Fee?	Yes No
*Commerical Interest or Exhibit?Yes No
*Do you need audio visual assistance?Yes No
*Do you need additional software installed on the computers?Yes No
If yes, what software do you need?
* Enter Text Shown Below: