Please use one form for each non-consecutive day rental
RETURN TO: Western Piedmont Community College, Attn: Melissa Freeman, 1001 Burkemont Avenue, Morganton, NC 28655
Phone: 828-448-3131 Fax: 828-448-6177 Email:
Contact Person:
Name of Organization:
State or Local Government
Federal 501(c)(3) Organization
Federal Tax ID # (9 digits):
There is no charge for state agencies, local government agencies and non-profit organizations. (Exception: cancellation fees)
Zip Code:
Phone Number:
Email Address:
Purpose of Planned Activity:
Number of Attendees:
Date Requested:
Time: from
Rooms are not guaranteed available past the times listed on this request
All rooms (except conference rooms) are equipped with a computer/data projector.
Drinks and/or food are prohibited in computer labs
IT Technician (fees apply):
Invoice Requested:
Microphone/Sound System (Moore Hall Leviton Auditorium only; technician fees apply)
The undersigned hereby represents themselves as an authorized agent of the aforementioned organization and, as such, makes application to Western Piedmont
Community College for the use of the College’s facilities. The undersigned warrants that the applicant will observe all regulations of Western Piedmont Community
College, will exercise the utmost care in the use of said premises and property, and will hold the Trustees of Western Piedmont Community College, the individual
members thereof, and all Western Piedmont Community College employees, free and without harm, from any loss or damage, liability, or expense that may arise, or be
caused in any way, by such occupancy or use of the College’s property.
I agree to the policies and procedures contained in the WPCC Policy Manual, Catalog and Student Handbook and accept financial responsibility for all expenses
iated with reserving and utilizing Western Piedmont Community College facilities, equipment, and services.
Applicant’s Signature
The following section is to be completed by Western Piedmont Community College staff:
Application Approved:
Application Approved with Conditions:
Application NOT Approved:
Conditions or Other Information:
Applicable Fees:
Rental Fees day(s) $ Fees Paid: $
IT Technician hours $ Date Paid:
Security hours $
Room Assigned:
Please remit payment within ten (10) days prior to the scheduled event to the following address:
Western Piedmont Community College, Attn: Business Office Cashier, 1001 Burkemont Ave., Morganton, NC 28655.
Choose one:
Submit Form
click to sign
click to edit
(This would be printed on the back of the application.)
Procedures for requesting use:
1. An inquiry to should be submitted to determine if the desired date and time is
available. Tip: Reservations can be made up to six (6) months in advance.
2. A temporary hold will be placed on the room for five (5) business days until an Application for Use of
College Facilities is completed and returned. If the Application for Use of College Facilities is not returned
by the due date, the room reservation will be canceled.
3. A copy of the room reservation form will be emailed to the applicant notifying them of the status of the
request for use of facilities and any applicable fees.
4. Upon notification of the request by the College, a check to cover the charges will be made out to Western
Piedmont Community College and sent to the Business Office ten (10) business days prior to the scheduled
event. If payment is not received by the due date the room reservation will be canceled.
NOTE: In the event that the User’s facility needs change prior to use of those facilities, a new Application for
Use of College Facilities must be submitted to the College to reflect the anticipated needs and the previous
reservation should be cancelled.
PROGRAM CANCELLATION POLICY: There is no charge for facilities cancelled by the requesting
organization if the request is cancelled seven (7) days prior to the scheduled event. Events cancelled with
less than seven (7) days’ notice may incur a cancellation fee.
Contractual Obligations:
The User agrees to hold Western Piedmont Community College free, harmless, and indemnified from any
claims, suits, or causes of action arising from or out of its use of a College facility.
A User shall not sign or transfer its use of College facilities to any other person or group without the express
written permission of the appropriate College official.
An agreement to use College facilities may be canceled or amended by either the User or the appropriate
College official for good cause provided seven days’ notice is given to the other party.
Amendments may be made only by mutual agreement of both parties involved. In addition, refund of the
usage fee or any portion thereof, where applicable, will be made at the discretion of the President or his/her
Violations of any of the College rules and regulations shall be grounds for the suspension of a User’s
privilege to use school facilities.
The User shall leave the College premises in a clean, neat, and orderly condition. In the event that College
property is damaged, the organization or entity booking usage shall be liable for the damages.
If the User finds the facility unkempt or not fit for the intended use, he/she should notify the appropriate
College personnel prior to the beginning of that use.
The User is responsible for the supervision of the activity (class meeting or event), including the
maintenance of order and the safety of the people present.
The user is responsible for materials and items left in a room overnight. Rooms are used by multiple groups
and the college cannot be held responsible for items left in the classroom.
Please note that we are not able to provide flipcharts, extension cords, coffee pots, or room arrangements.
Users are responsible for arranging rooms and returning them to the order in which they were found.