EmailMeForm
Flex Event Request
Mesa College
Flex Event Request Form
Complete and submit form at least 5 working days prior to the event.
Only one event per form.
If approved, you will receive the flex number by email.
Presenter/Facilitator Name(s)
*
Requester email
*
Department
*
Phone
Event Title:
*
Event Location
Reserve locations through the
Events and Planning Portal
. To reserve the
LOFT
or
LOFT 432
use the LOFT Reservation form
. Note if the event is off-campus.
Zoom Link/Login Information
Workshop Capacity
*
# Flex Hours
*
Start Date
*
MM
/
DD
/
YYYY
HH
:
MM
AM
PM
AM/PM
End Date
MM
/
DD
/
YYYY
HH
:
MM
AM
PM
AM/PM
Would you like to add this event to the Professional Learning Training and Events Calendar?
Professional Learning Training and Events Calendar
Yes
No
Workshop Proposal
Project Type- Select all that apply
*
Course instruction and evaluation (1)
Staff development, in service training and instructional improvement (2)
Program and course curriculum or learning resource development and evaluation (3)
Student personnel service (4)
Learning resource service (5)
Related activities, such as student advising, orientation, matriculation services, and student, faculty, and staff diversity (6)
Department or division meetings, conference workshops and institutional research (7)
Other duties as assigned by the District (8)
The necessary supporting activities for the above (9)
Address these three items:
-Describe the event.
-Explain how this activity is tied to what was selected under 'Project Type' above.
-Explain how it will improve instruction.
*
Additional Instructions (cost to participate, accommodations, repeated dates, etc.)
Signature
Clear
Draw your signature in the box
