Service request form

Contact information of the resource person

First name

Last name

Telephone

Information related to the service request

Name of the activity

Desired dates (please suggest 3 dates)

Start time

End time

Flexible date and hours ?

Desired location

Number of participants

Reason for the request (meeting criteria for obtaining a document, meeting a need within a unit, etc.)

Format of the activity

Activity offered live or online

Nature of the activity

Will the activity be repeated?

If so, how often (semi-annual, annual, etc.)?

Information related to the description of the activity

Material needs

Learning objectives of the activity

Information related to the budget of the activity

Use of the budget:

Do you have a budget for this activity?

If so, what’s the amount of your budget?

Information related to the instructor / speaker of the activity

Organization of the instructor / speaker

First name

Last name

Telephone