Request Form

Ellsworth Facility Use Request Form

This form is for individuals or groups requesting use of Ellsworth Community College facilities. Once you submit the form, we will contact you by phone or email to discuss rental fees and any other needed information. Questions can always be directed to Dee Carr at 641-648-8501 or Deanna.Carr@iavalley.edu.
Requester Name(Required)
MM slash DD slash YYYY
If the event is for more than one day, specify additional dates here.
Start Time(Required)
NOTE: To indicate 3 pm, put 03 in the HH field and 00 in the MM field. Two digits are required for the hours and minutes of the time specified.
End Time(Required)
Use this space if we need more description of the event timing.
Rooms Requested
Room Set-Up(Required)

Please describe how the tables/chairs should be set up for your meeting. If you do not need a special set-up, please type AS IS and the room will be set-up in typical classroom style.
Room Setup Required By:(Required)

Technology Needs
Each room is equipped with a PC, laptop connection, CD/DVD player, and projection equipment. ZOOM technology is available upon request. Please describe your event technology needs in as much detail as possible, so we can ensure your event will be successful. If no technology is required, please type NONE.
If you need catering, Great Western Dining at ECC has first right of refusal per their contract with IVCCD. To arrange catering contact: Chris Strawhacker at 641-648-8553 or ECCfoodservice@iavalley.edu
Alcohol served?(Required)
If you intend to serve alcohol at your event, you will need to provide proof of insurance, and your request will need to be reviewed and approved by the President's office. Thank you for your understanding.
A copy of this Facility Use Request Form will be emailed to the Customer Service Specialist, ECC Plant Services. The Facility Use Agreements Request Forms will also be sent to the Library Services Manager, Student Support Specialist, Ag & Renewable Energy Center, The Dale Howard Family Activity Center Director if rooms in those buildings are being requested. You will receive a meeting confirmation from ASTRA, which will be your notification that everything is in the system. If we have questions, you will bet a call or email from the Customer Service Specialist. Thanks for using this form.
Special Information(Required)
* In accordance with the Iowa Smoke Free Air Act, use of tobacco or vaping products is not allowed on any of our grounds or in our facilities. This includes all buildings, grounds, sidewalks, parking lots, vehicles on campus, and streets within the campus. * Charges will be assessed for damages, abuse or theft of college property directly attributable to negligent acts or omissions of the customer and/or your employees, representatives or invitees. * Contact Dee Car at Iowa Valley if there are changes to any of your meeting plans or facility requirements. There may be a charge for changes made with less than three business days' notice before the event.
This field is for validation purposes and should be left unchanged.