Facility Request Form

Submission of the following form is a formal request to use the facilities and/or services of Penn State Harrisburg. Note that all requests are subject to approval; submission of the request form should not be considered an approval for use of facilities and/or services.

Notes:

  • Groups must have an educational component.
  • Most facilities and services have associated fees. An estimated fee schedule will be provided for requests that meet initial approval.
  • Programs involving minors (under the age of 18) are governed by Penn State Policy AD-39.
  • The use of the Penn State name is limited to the location of approved events, as per Policy AD-03.

Please complete the following form in its entirety; incomplete forms will not be processed.

Contact Information
(e.g. xxx-xxx-xxxx)
Event Information
Participant Makeup
Please indicate the projected number of participants for this event, broken out by number of minors (younger than 18 years old) and legal adults (18 or older).
Reminder: Programs involving minors are governed by Penn State Policy AD-39.
Have you utilized our space for this event in the past?
Services Requested

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