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Please fill out the CASIT Facility Reservation Request form and email your request to CASIT@mednet.ucla.edu. We will then be able to confirm the reservation appropriately, considering the information and details provided and CASIT’s ability to support the event.

Requestor's Name:

Requestor's Email:

Requestor's Phone Number:

Requester's Job Title:

Requester's Department:

Meeting Date(s):

Start Time(s):

End Time(s):

Meeting / Event Title:

Faculty Lead:

List the names of the instructors for your event:
Enter "N/A" if you have no instructors.

Day of Event Contact Name and Phone Number:

Re-occurring:

Yes
No

End date of series:

Description of Meeting/Event:

Number of Attendees:

Please choose the type of location:

CASIT Conference Room (capacity: 30 people)
CASIT Education Lab (capacity: 24 workstations, maximum 72 learners)

IT Services:

Yes, please describe
No

Audio & Visual:

Supplies (Consumables for purchase):

Please note: If you would like CASIT to purchase consumable supplies on your behalf, please have your budget and FAU/Recharge ID/Cost Center approved by your department a few weeks prior to scheduled event.

Sutures (specify type, needle, size, and quantity)
Surgical blade (specify size and quantity)
Biosynthetic tissue (skin or organ, and quantity)
Foley Catheters (specify size and quantity)
Nasogastric Tube (specify size and quantity)
Vascular grafts (specify size, type, and quantity)
Other, please describe (specify type, size, and quantity)
No supplies needed.

Supplies (Consumables for purchase):

If you have selected consumables for purchase above, please enter your department's FAU/Recharge ID/Cost Center below.

Catering:

Yes, please provide food service and contact person info:
No