Orange County Community College
Central Scheduling Office
115 South Street
Middletown, New York 10940
Phone: (845) 341-4720 Fax: (845) 341-0683
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: __________ Day of Week:__________ Actual Start Time: ________ End Time:_______
Event Location: Building: ______________________________ Room: __________________
Person(s) directly in charge of
dispensing alcoholic beverages:
(verify age)
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 and 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
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 Alcohol Service Request Decision
Requestor Name: ____________________
Event Date: ___________
____ Approved ____ Disapproved
Comment: _______________________________________________________________________
________________ ____________________________________
Date Dr. Kristine Young, President
Alcohol_Permission_Request_Form.pdf Revised Dec 2017
click to sign
signature
click to edit
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