2023-2024 LGBTQ CRC Student Organization Space Reservation Form

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Please complete this form to reserve the UCLA LGBTQ Campus Resource Center for regularly occurring student organization meetings. For one off reservations, please email Jaime Estepa at jestepa@lgbtq.ucla.edu or Minnie Esquivel Gopar at mgopar@lgbtq.ucla.edu to inquire about space availability.

Email *

Name of student organization *

First and last name of the person completing this form *

Email of the person completing this form *

First, last name and emails of additional org leaders *

Names of organization representatives to add to the LGBTQ CRC access list and assume responsibility for the space (maximum 3 folks) *

The access list allows students to go to the SAC Pool Desk and open the LGBTQ CRC if the Center is locked when an org meeting starts. Any student listed on the access list assumes responsibility for the Center during the time the org has the space reserved and will be held liable for following Center closing procedures. *Names listed should match the student's name as it appears on their BruinID.*

Please list your top three days/times you would like to request to your reservation? *

ex: (1.) Thursdays, 6-7pm, (2.) Wednesdays, 7-8pm, (3.) Mondays, 6-7pm

Does your org plan to meet weekly Week 1 -Week 10? *

Yes

If your org does not plan to meet weekly, how frequently would you like to reserve space?

Ex. Wednesdays of odd weeks; Tuesdays of weeks 3, 5, and 8; etc. Please be specific!

Space Requested - At this time, we are only allowing one org to meet at the Center at a time, due to Covid-19 limited person capacity. *

Lounge (10 people max)

Library (5 people max)

Entire Center (15 people max)

For which quarter are you requesting a space reservation? *

Fall

Winter

Spring

Required

What is the mission/purpose of your student organization? (i.e. how do you uniquely support LGBTQ life on campus) *

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