Orange County Community College
Central Scheduling Office
115 South Street
Middletown, New York 10940
Phone: (845) 341-4720 Fax: (845) 341-4721
APPLICATION FOR USE
OF FACILITIES BY
OUTSIDE ORGANIZATION
Event Date: _______________
Name of Organization: __________________________________________________________
Billing Address: ________________________________________________________________
Name of Applicant: _____________________________________________________________
Name of Contact Person: ________________________________________________________
Telephone: (Day) _________________________ (Evening) _____________________________
Facility Requested: _____________________________________________________________
Title of Event: __________________________________________________________________
Day & Date(s) of Event: __________________________________________________________
Description of Event: _____________________________________________________________
Hours Requested for Facility: _______________ Actual Time of Event:_____________________
Supervisor of Event: _______________________Sponsor of Event: _______________________
Approximate Attendance: __________ Special Needs? _________________________________
(If you need any special set up, please include a floor plan.)
Will event be open to the general public? ______ (Y/N) Admission cost? $_________________
If admission is charged, how will the proceeds be used? ________________________________
Will you be serving food? ________ (Y/N)
Who is your Insurance Agent? ______________________________________________________
Please provide a certificate of your insurance coverage which lists Orange County Community College as
an additional insured. Our requirements are for a general liability of three million dollars. This certificate
of insurance is essential to complete this application.
In case of any illness and/or injury to any participant, please notify the Safety/Security office by calling
(845) 341-4710 and/or the campus nurse at (845) 341-4870.
If you plan on using the colleges name or logo for any advertisement, publication, or promotion regarding this
event, please contact Vinnie Cazzetta, the college’s Vice President for Advancement at 845-341-4726, for
approval.
Your group will accept full responsibility for ticket sales/distribution, and publicity. Please read policy
statements on the reverse side and sign the application before returning it to the Central Scheduling
Office. Application must be submitted at least thirty (30) working days before the event. If the form is not
completed properly, (i.e. special needs not listed), your reservation may be affected.
Note: Maintenance fees may be applied if cleanup is required and not paid for in advance
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