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    JSIS BUILDING USE REQUEST FORM


    For JSIS, PTSA or LSA


    EVENT DETAILS

    Name of Event and Description:

    Organization (JSIS, PTSA, or LSA):

    Room(s) Requesting:

    Date(s):

    Time needed: Set-up time (if applicable): Event Start time:

    Event End time: Clean-up End time (if applicable):



    Total # of People:
    #Adults:
    #Children:



    Please indicate additional services for your event:

    Custodian ☐ Heating/Cooling ☐ Lighting ☐ Other services:

    Additional information about the event:

    ROOM REQUESTOR INFORMATION

    Requestor Name:

    Phone#: e-mail address:

    REQUIRED AUTHORIZATION(S)
    Do not submit form without the applicable signatures

    All PTSA events: PTSA President signature (or attach approval e-mail):

    Events utilizing JSIS Library require Ms. Kathleen’s signature:

    Principal signature (or attach approval e-mail):

    Submit completed forms including required signatures to JSIS Office
    johnstanford@seattleschools.org
    Office Use Only



    Schedule ID#:
    Date entered:
    On Master Calendar: ☐