S TUDENT S UCCESS C ENTER
Learning Lab Reservation Form LR118
Please attach all information relevant to this reservation
Today’s Date: ______________________
Reservation Day/Date (s): ____ Reservation Time (s): ____
____ ____
____ ____
Course: ______________________
Instructor: ______________________ Instructor’s Extension: ______________________
Instructor’s email: ______________________
Number of Stations Needed: ________ Projector? Yes ________ No ________
Room Divider? Yes ________ No ________
Roster Attached: Yes ________ No ________
Please submit this form through email to studentsuccess@csmd.edu, through
interoffice mail or in person in the Student
Success Center, LR120.
You will receive an email confirming your reservation. Thank you
For SSC Use Only
Date Entered on Calendar/Initials:______ Approved by:______
I:\Dept&Divisions\SSC\Learning Lab\Documents\Learning Lab - Lr118 - Reservation Form.docx
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