MSA - Temp Black House Reservation

MSA - Temp Black House Reservation

This form serves as the formal process to request a spaces in the temporary Black House. MSA recognizes space is an important resource in supporting marginalized communities. Therefore we prioritize reservation request that align with our mission and the many communities we serve. Request to reserve a space must be submitted at least two weeks in advance. All requests are subject to review. Your reservation is not confirmed until you receive a confirmation email from MSA.

Since the early 1970s the “Black House” has been a home away from home for Black students at Northwestern. The University created the space in fall 1968 as part of its agreement with students to end the Bursar’s Office takeover in April of that same year. In the “Black Student Statement and Petition to Northwestern University Administrators, April 22, 1968,” students wrote: “We demand a Black Student Union, a place to be used for social and recreational activities. … Black students have nothing at Northwestern to call our own. We need a place where we will feel free to come and to go as we please.” Since 1968, and then when the Black House moved in 1972, the Black house has been and continues to be that place.

In order to honor the legacy of the Black House, MSA prioritizes events and student groups that center Blackness for reservations in the Black House. Please be mindful of the legacy of this space when submitting your request. MSA staff will respond to your request within 48 business hours. Please contact msa@northwestern.edu with any questions.

Name Name * First Last
Your affiliation with the University: *

Your affiliation with the University: Undergraduate and Graduate Student Faculty/Staff/Graduate Assistant Community Member
Phone Phone * - ### - ### ####
Email *
Organization/Department *
Title of Event/Meeting *
Event Description:
Please be specific; for example: board meeting, panel discussion, film screening, food provided. *
Which space would you like to request? *

Which space would you like to request? 1st Floor Conference Room Lower Level, TV Lounge 2nd Floor, Conference Room Kitchen/Pantry
If the space you requested is not available, would you like to request one of our other spaces? If so, which one?

If the space you requested is not available, would you like to request one of our other spaces? If so, which one? 1st Floor, BH Conference Room 2nd Floor, BH Conference ROom Lower Level, BH TV Lounge 1st Floor, Multicultural Center Conference Room
Expected number of guests/attendees (enter numeric values only): *
Must be a number less than or equal to 100.
The audience will include: *

The audience will include: Northwestern students, faculty and staff Other University students Local community members
Date of desired reservation Date of desired reservation * / MM / DD YYYY
Start time of desired reservation Start time of desired reservation * : HH MM AM/PM
End time of desired reservation End time of desired reservation * : HH MM AM/PM
Is this a recurring event/meeting? (This reservation will be for the duration of the quarter) *

Is this a recurring event/meeting? (This reservation will be for the duration of the quarter) Yes No
Will you need to utilize the T.V. in the space? (see all options) *

Will you need to utilize the T.V. in the space? (see all options) Yes, and I will need a Mac adapter Yes, and I will need a HDMI adapter Yes, but I will bring my own supplies No, I will not utilize the T.V. in the space
Will food be served at your meeting? *

Will food be served at your meeting? Yes No
If answered "Yes," please describe what food with be served. You must complete this answer if you answered "Yes." *
I accept responsibility for cleaning up all left over food and trash from the space. Left over food cannot be stored in MSA spaces. *

I accept responsibility for cleaning up all left over food and trash from the space. Left over food cannot be stored in MSA spaces. I accept
I understand that this form is a request and not confirmation of reservation. I understand that I am responsible for this reservation and cannot transfer it to another person/group/department. I understand that I must submit a request at least 2 weeks in advance, and that the MSA staff will respond to me within 48 business hours.

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