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Indiana University Kokomo
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Kelley House Event Form

Please fill out this form completely, then press the submit button. We prefer that reservations be made at least two weeks in advance. The completion of this form is only a request for use of the Kelley House on the IU Kokomo campus. It is not an automatic or completed reservation. The person responsible for this request is cautioned that no advertising of the event is to be released until the reservation has been confirmed by LeeAnn Mulkey coordinator of Kelley House events. The event checklist form must be filled out and submitted along with this request.

The requestor is responsible for providing information on the room setup and or equipment needed. For catering and AV needs please contact Tara Scott at 765-455-9449 or tarscott@iuk.edu

Event Information

Event Title: 

:

Sponsor (Department or organizer)
Event Date 1: [mm/dd/yyyy] 
Event Date 2: [mm/dd/yyyy] 
Event Date 3: [mm/dd/yyyy] 
Event Date 4: [mm/dd/yyyy] 
Event Date 5: [mm/dd/yyyy] 
Start Time:   (hh:mm) a.m. p.m.
End Time:   (hh:mm) a.m. p.m.
Attendance Expected: 

Number of IU Employees:

Number of Student:
Non-University:
Equipment Required:

Screen
Flip Chart
No Equipment Needed
Podium
Guest Accounts

Room Setup (list specific needs)

Food Service Information

Is food service required?

No 
 Yes 

Please fill out the link for food service request form.

For guests that will be using the Kelley House overnight:

[3 suites available]

[mm/dd/yyyy] [hh:mm]

[mm/dd/yyyy] [hh:mm]

[first/last]

[first/last]

[first/last]

[first/last]

Smoking Policy

Reminder that Indiana University Kokomo is a tobacco free campus, use of tobacco anywhere on campus is prohibited, including the Kelley House.

Contact Information:

Contact Person:  
The contact person should be the individual making the room request.
Room Number: 
Phone Number: 
E-mail Address:
Please use FULL email address in this field (yourname@domain.com)
Additional Comments: 
(if you require additional dates for recurring reservations, please enter that information here)

An e-mail confirmation will be sent to the contact person listed above when the request is processed.

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