Screening Room Request Form

This form is to be used for COM School Faculty/Staff and student requests ONLY. Non-COM School related requests should be directed to Tech-Ops GA at 757.352.4807.

All requests require advance notice of at least three business days. It cannot be guaranteed that any request made with less than three business days advance notice will be processed.


*required information


Screening room*:

"A" (seats 91)
"B" (seats 42)
"C" (FTV Dailies)

Requested by*:



Class Name/#*:

Contact Phone #*:

Regent Email*:



Requested Date(s) of Reservation*:

Requested Times:


Set-up Time*:

Media Start Time*:

Media End Time*:

Estimated End of Reserved Time*:



Purpose of Reservation*:

Type of Presentation*:

Student usage of the SMART PODIUM, computer, video playback and/or projection equipment in either Screening Room, requires the attendance (for the entire time of the reservation) of the faculty member who oversees whatever project the student is working on, to oversee usage of the room and said equipment, and to login and logout of the Podium.

Enter the name of the overseeing Faculty member:

IF SELCTED RU Film(s) & Commercial Film(s):







NOTE: If this is a Commercial Film...

Will this screening be a part of a regularly scheduled University class discussion led by the Instructor of that class dealing with the specific content or style of the film?
Yes No

If the answer to the question above is "No", have you obtained proper licensing for this film?
Yes No

Please forward a copy of the Licensing Agreement to COM Bldg. Operations Mgr. at least 24-hrs prior to the scheduled Film Screening.   David Garcia – COM-224



Number of People expected to attend*:

Will non-Regent University personnel be invited to this activity?*

Yes   No

If so, in what capacity?:

Meeting or Screening attendance by any non-Regent University personnel may require payment of a fee to cover the costs associated with the hiring of a House Manager to be on site to assure the safety of an off-campus audience. You will receive an e-mail noting the estimated cost associated with this event, along with the confirmation of the reservation of the room.

Non-SCA usage of either screening room may incur a fee (or fees) associated with projection and/or theatrical lighting lamp usage, as well as possible charges to cover a Projectionist and House Manager, if required. An estimate of the Chargeback costs associated with this reservation will be sent to the requestor, along with the provisional confirmation of the reservation.

Special Requests:



I have read and do understand the policies set forth by the School of Communication & The Arts for use of the Screening Room(s) and, with submission of this form, attest that I take full responsibility to make sure that my group abides by these policies and leaves the room in the same condition as it was found. I further agree to make a check available, in advance of my event, for any applicable room and/or personnel charges levied for use of the room. I further understand that failure to abide by any of the policies set forth in the attached document may result in a $100 surcharge.

I understand and agree*: