Facilities Request Form
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Steelton-Highspire High School
Steelton-Highspire Elementary School
250 Reynders Avenue, Steelton PA 17113
Name of requesting organization:
Name of contact person:
Email Address of organization contact:
Address of organization/Zip code
Date of Request:
Begin Date of Event:
End Date of Event:
Time of Event:
Room number or area to be used for the event:
Type of Event/Description:
Number of persons attending:
Is there a charge for this event/activity? If so what is the charge?
By selecting yes you certify that you are the person listed on this form and are certifying that you are authorized to fill out this form and make this request on behalf of the organization listed. A completed form will be sent to the contact listed on this form once the request is approved and a real signature will be required.
To be completed by Facilities Administrator:
The requested facility is available Yes or No:
By selecting yes the Facilities Administrator is acknowledging that the request has been responded to.