Form Contact:
For general questions or inquires about scheduling, please contact:

Dr. Leland Rockstraw, Director of CELR
Telephone: 215-762-4115


Form Instructions:
Please fill in the items below items with red asterisk * are indicated as required
fields SUBMIT to send this information to a CLRC Staff Member. For a submission
example, please click Sample Submission Form

Submission Instructions:

1. The room request must contain the name and phone number of the person
   filing the request.
2. The course name must follow the following formats:
• Nurs 300 - Comprehensive Adult Nursing
• Nurs 303 -Women's Health Workshop
3. You may select more than 1 day per submission for the same course
   reservation only.
4. Please select a range of students that best fits your courses needs
5. Select your primary room followed by a secondary/alternative room.
   In order to request 2 rooms you must check the box marked 'check to request
   both rooms
6. If you request linens, you will be supplied with the max number of students requested plus an additional 20%
   • 40-60 Students will yield the following when towels are requested:60 students x 20% = 12 additional towels for a total of 72 towels
   • You may request additional linens in the Notes/Special Instructions Field
     NOTE: Incomplete requests will be declined