Orange County Community College
Central Scheduling Office
115 South Street
Middletown, New York 10940
Phone: (845) 341-4720 Fax: (845) 341-4721
REQUEST FOR PERMISSION TO SERVE ALCOHOLIC BEVERAGES ON CAMPUS
Requestor Name: ___________________________________________ Today’s Date: ______________
Group/Organization to be served: ________________________________________________________
Event Name:
Event Purpose/Description: _____________________________________________________________
Event Date: ____________ Start Time: ________________ End Time: __________________
Event Location: Building: ______________________________ Room: __________________
Person(s) directly in charge of
dispensing alcoholic beverages:
Will non-alcoholic beverages be available for those preferring same? ________ (Y/N)
Will non-OCCC affiliated persons be among guests? ________ (Y/N)
If yes, please provide a general description of this group:
I understand that no alcoholic beverage can be sold at the above event a
nd that no person under 21
years of age can be supplied with an alcoholic drink.
_____________ _______________________________________
Date (Signature of person making request)
PLEASE SUBMIT TO
:
THE OFFICE OF THE PRESIDENT
ORANGE COUNTY COMMUNITY COLLEGE
115 SOUTH STREET
MIDDLETOWN, NY 10940
SUNY Orange FACULTY/STAFF
Alcohol Service Permission Form
Event Date:
___________
The President’s decision will be
returned on this form.
Approval is not to be assumed unless
this form is returned.
Do Not Write In Shaded Area Below
SUNY Orange Employee Alcohol Service Request Decision
Requestor Name: ____________________
Event Date: ___________
____ Approved ____ Disapproved
Comment: _______________________________________________________________________
________________ ____________________________________
Date WILLIAM RICHARDS, PRESIDENT
click to sign
signature
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