Hands-On Lab Usage Request
Physical Science 206
Usage Policy: Requests for lab usage will be taken at any time. Submit request to the Center for Mathematics
& Science Education where the calendar will be kept for the lab. Requests will be accepted based on the Usage
Priority Levels below. Respond to all items below in order for the request to be considered complete.
Event Description:
Event population (i.e., univ. students, middle school, etc.): # of Participants:
Request Date(s): Time (e.g., 8a-12:30p):
Requested By (responsible party): Email:
Usage Priority Level:
1. Science Education Class (Official courses in HOL, including lab prep and clean-up.)
2. Programs and activities supported by CMSE or the Science Education Group.
3. Other science/math education activities in line with CMSE goals.
(see http://www.csuchico.edu/cmse)
4. College of Natural Sciences and other College units’ requests that do no fit into categories 1-3.
5. Other university requests.
Justification of priority level (please attach additional sheet if necessary):
Equipment/Materials needs (please check any boxes that apply):
Microscopes Smart Board Burners
HOL program activity materials; activity name:
Other Other
No other equipment/materials needed.
It is assumed that any use of the lab will result in perfect condition after usage. Clean up will be required after
each use of the lab and, if not, further usage will be revoked. Requesting party is responsible for any breakage
and replacement of equipment. Please Initial _______
Requests for usage will be considered only after science education classes are scheduled. Entire semester usage
requests will rarely be approved, however may be allowable. Please provide additional documentation that
existing facilities are not available or why PHSC 206 is better suited than other alternative facilities.
Please return request to the Center for Mathematics & Science Education, Holt 377, zip 530.
A response to the requests will be provided by email as soon as possible.
**Internal Use Only**
Request approval date: _____________
NOT approved: ___________________
Requestor Notified date: ____________
