Classroom & Outdoor Space Request Form
All requests for the Immersive Learning Center must use the ILC Request Form (go to: http://medscheduler.stanford.edu).
All fields marked with an * are required.
Requester First and Last Name
Requester Phone Number
Is this request for the current academic year, or the next academic year?
2017-18 (Thru August 26, 2018)
2018-19 (August 27, 2018-August 25, 2019) -- will be confirmed late summer
SCHEDULING TIMELINE - PLEASE READ
We are currently scheduling events in the 2017-18 academic year (through August 26, 2018).
Requests for 2018-19 (August 27, 2018 to August 25, 2019) will be scheduled and confirmed in mid- to late-summer after all required and elective courses have been scheduled for the academic year. Course scheduling will commence on June 25, 2018. Please do not call and/or email medscheduler to check on the status of your 2018-19 request. Starting in mid-July, you can check the status of our summer scheduling project here:
Name of Event
School of Medicine-Other
SHC (Stanford Hospital and Clinics)
Office of Development
Berg Hall Conf. Center Event Participants
For recurring meetings, list pattern and date range (i.e. first Tuesday each month starting 9/5/17-6/5/18)
Is this a one-time or recurring event?
Preferred Building/Room Number
Alternate Building/Room Number
Other Space Options
If the "Preferred" and "Alternate" Buildings/Rooms you listed above are not available, would you like us to schedule other available space(s)?
Are you requesting the Alway M206 computer lab?
If yes, computers should be booted in:
Either is ok
Is certification of machines required? (i.e., In-training exams, NBME)
Does your event require software other than what is listed here: http://med.stanford.edu/irt-resources/classrooms/features/softwarelist.html
Select Resources Requested
Videocapture -- NOTE: The School of Medicine classroom capture system is not an approved host for any media content (video, audio, or .ppt/.pdf) that contains patient health information. Any classroom lecture media found to contain PHI will be removed immediately. In the rare case that you have explicit written consent from a patient to capture and publish content that contains PHI/HIPAA, please select that option in the Stanford Medicine Speaker Release form (https://stanfordmedicine.qualtrics.com/jfe/form/SV_6SfRsWnMPKqlw0d). If you have a need related to PHI, your first and best choice would be to consult with the University Privacy Office (https://privacy.stanford.edu/contact-us).
Audio/teleconferening (i.e. conference telephone or Zoom audio)
Videoconferencing (NOTE: The University has recently switched from BlueJeans to Zoom videoconferencing. For more info and to get started with Zoom, go to: https://uit.stanford.edu/service/zoom).
If videoconferencing, will you require AV assistance with your videoconference?
If using Zoom, please list your Zoom Meeting ID
Number of laptops requested:
Do the laptops need to be internet enabled?
Yes, wireless internet is acceptable
Yes, ethernet (wired) internet is required
No, only software is being used
Number of polling devices requested:
All catering in the LKSC, with the exception of approved student groups, must be scheduled with Catering at LKSC (650-725-6883 or email firstname.lastname@example.org). There is no restriction on vendors for rooms in other buildings.
Please schedule setup and takedown time for your catering so that events before or after yours are not impacted. Please make sure all catering is picked up before vacating the space.
PLEASE NOTE: It is the responsibility of the requester to make sure that all catering is removed from the classroom when they vacate the room.
Will there be catering for this event?
AFTER HOURS EVENTS (weekends and after 9pm on weekdays for both indoor and outdoor spaces) ARE REQUIRED TO PAY FOR AFTER HOURS HOUSEKEEPING.
I WILL SUBMIT A "CUSTOMER FUNDED" WORK ORDER (
) or call 650-721-2146 to schedule cleaning of classroom(s) and cleaning and restocking of nearby restrooms (have PTA available) AT LEAST ONE WEEK IN ADVANCE OF MY EVENT for all after hours requests.
By checking this box, I attest that I understand these policies.
Affirmation of Understanding of Additional Policies
a) The Scheduling Office should be notified of session cancellations.
b) Setup and takedown time should be scheduled when using catering. If setup/takedown time isn't available, I understand catering will be delivered/picked up during my session.
c) Projection systems should be shut down at the end of my session.
d) AV Tech classroom support hours are Monday through Friday, 7am to 6pm. There is no AV Tech support available on University holidays (
). f) Room should be returned to the original condition (i.e. furniture layout, trash) and vacated on time. I UNDERSTAND THAT SUBMITTING THIS FORM IS ONLY A REQUEST, THE RESERVATION IS NOT FINAL UNTIL I RECEIVE A CONFIRMATION Please be sure to check the confirmation for accuracy and contact the Scheduling Office (email@example.com; 650-723-6952) for any reservation changes, cancellations and/or questions regarding equipment/technologies in our spaces.
Additional equipment (tables, chairs, etc.) may be reserved through University Events Services (650-723-2285;
I understand the policies.
Please check the checkbox below to receive a copy of your request.
Send me a copy of my responses
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