Academic Breakout/Event Form

Email (Required):
Submitter's Full Email (e.g. jsmith@csusm.edu)

CC:
Indicate if you would like other individual(s) CC'd upon completion of request

Event Title (Required):

Term (Required):

Subject (Required):
e.g. CS, DNCE, GEW

Catalog Number (Required):
e.g. 100, 310, 498A

Section Number (Required):
e.g. 07, 10, 11A

Class Number (CRN) (Required):
5 Digits (e.g. 42115)

Faculty Member Name:

First:

Last:

Date of Event (Required):
Example: March 21, 2024

Time of Event (Required):
Please use Military Time (e.g. 1600-1715 instead of 4:00 PM - 5:15 PM)

Type of Room Needed (Required):

Preferred Building or Classroom (Required):
Please find an available room in 25Live.

Number of people who will be attending (Required):

Comments:
Anything extra we should know about your event.