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 ask us at LibClassroom@utsouthwestern.edu.

* 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 UT Southwestern Medical Center UTSW - St Paul UTSW - Zale Lipshy UTSW Austin Programs Other

Department:

* Email:

Phone:

*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

Faculty Nurses Residents

(check all that apply)

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: