Fillable Campus Activity Proposal Form (Berkeley City College)

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Campus Activity Proposal Form (Berkeley City College)

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The Campus Activity Proposal Form (Berkeley City College) form is 5 pages long and contains:

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  • 18 check-boxes
  • 76 other fields

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File type: PDF

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Berkeley City College
Campus Activity Proposal Form
This form shall be used for all approved student organizations,
faculty & staff.
PLEASE READ BEFORE COMPLETING THIS FORM:
1. Please check the date availability of your desired activity by visiting our Berkeley
City College website event calendar; a request does not guarantee a reserved space.
2. Your request must be submitted 4 weeks prior to the date you desire or the activity
cannot take place.
3. Please make sure you have obtained all approvals/signatures prior to submitting
this request. Your request will not be considered unless you have all the required
signatures.
4. Please attach a short summary of the activity or event you are requesting.
5. Please do not assume your request is approved until you have received
confirmation that it has been approved. Therefore, please do not advertise, book
speakers, or make arrangements until then.
RETURN THESE FORMS TO: Office of Student Activities & Campus Life Room 151
(510) 981-5012 email: bcc-campuslife@peralta.edu
TYPE OF ACTIVITY REQUESTED:
□ Event
□ Tabling
□ Meeting
□ Class/Instruction
□ Other: _________________
Name of activity: _________________________
Brief description of activity: (attach additional
sheet if needed)
_________________________________________
LOCATION:
□ Atrium □ Auditorium □ Student Lounge 5
th
floor □ Classroom □Welcome Center
□ Other: _________________ Will you require audio visual, IT support, or custodial
assistance? □ YES* □ NO
*If yes, please fill out attached request forms
DATE & TIME REQUESTED:
Day of week: ____________________ Date: _____________________
Prep time before: ________ am/pm. (Includes decorating, displays, hangings, etc.)
Beginning time: _________ am/pm. End time: _________ am/pm. You have up to 1
hour to remove all decorations; it is your responsibility and we are not responsible for
any lost, stolen, or damaged items before, during, or after your activity/event.
Comments: ______________________________________________________________
REQUESTOR INFORMATION:
□ Student Organization* □ Faculty □ Staff
*For student Organizations, please fill out the “student organization” section on the next
page
Name of requestor: ____________________________ Student ID#:________________
(PRINT LEGIBLY) (STUDENTS ONLY)
Requestor signature: _____________________________ Date: ___________________
Email (required):_________________________ Phone number: ( ) _____________
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FACULTY/STAFF ONLY:
Please have your administrator sign and date below upon their approval.
Administrator name (PRINT):________________________ Dept.___________________
I hereby approve the activity requested by the faculty/staff person listed on this request form.
Administrator signature: _____________________________ Dept.___________________
STUDENT ORGANIZATIONS
1. Faculty Advisor Approval:
By signing this request you are indicating your approval and your intention to be
present at the event and that you have read and confirmed that the application is filled
out correctly. Failure to follow procedures, timelines and filling in necessary
information, may lead to disapproval of the event. Last minute changes may not be
possible and requests must be submitted 4 weeks prior to the requested activity or it
may be denied.
Faculty advisor name: _______________________________________________________
(PRINT LEGIBLY)
Faculty advisor signature: ____________________________Date:___________________
Faculty advisor email: _______________________ Advisor phone: ( ) _____________
FOR OFFICE USE ONLY
□ Approved □ Denied
__________________________ Date: _______________
Signature of administrator
Name of administrator (PRINT): __________________
If denied, reason: ___________________________________________________________
Date/location available and
reserved on calendar by:
Campus Life Staff:
Name: __________________
Signature: _______________
Date: ___________________
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Name of activity: _________________________ Date/time of activity: _________________
ATRIUM SET-UP REQUEST
CUSTODIAL:
We currently have the following equipment available. Please list below what you’ll need.
Approximately: 2 podiums, 40 tables, and 100 chairs (please inquire regarding easel availability).
Number of podiums: __________________ Number of tables: _________________
Number of chairs: ____________________
Comments:
_________________________________________________________________________________
_________________________________________________________________________________
AUDIO VISUAL/IT:
(Microphones may only be used in the Atrium between 12:15 – 1:15 Monday – Friday)
Regular microphones
# on stand____________ # on podium____________ # on table_____________
*PLEASE FILL IN ATTACHED DIAGRAM FOR YOUR DESIRED SET UP
CUSTODIAL:
We currently have the following equipment available. Please list below what you’ll need.
Approximately: 2 podiums, 22 tables, and 107 chairs (please inquire regarding easel availability).
Podiums on stage: __________________ Tables on stage: ___________________
Chairs on stage: ____________________
Comments:
_________________________________________________________________________________
_________________________________________________________________________________
Auditorium outside/entrance request:
Tables outside/entrance: ______________ Chairs outside/entrance:_____________
AUDIO VISUAL/IT:
Cordless microphones on stage:
# on stand___________ # on podium___________ # on table____________
Regular microphones on stage:
# on stand___________ # on podium___________ # on table____________
*PLEASE FILL IN ATTACHED DIAGRAM FOR YOUR DESIRED SET UP
AUDITORIUM SET-UP REQUEST
ATRIUM/BASEMENT LEVEL & AUDITORIUM/ENTRANCE SET-UP
STUDENT LOUNGE 5
TH
FLOOR
WINDOW WALL SIDE
FIXED FURITURE SITTING AREA
GLASS 51/57 CLASSROOM WALL
BENCH AREA
FIXED FURNITURE SITTING AREA
RESTROOM
RESTROOM
STAGE AREA
(MARK SET-UP)
ENTRANCE
ENTRANCE
FIXED FURNITURE SITTING AREA
FIXED FURNITURE SITTING AREA
VENDING
MACHINE
AREA
VENDING
MACHINE
AREA
BOOKSTORE
FIXED FURNITURE SITTING AREA
ENTRANCE
ENTRANCE
Amount available
Item
Quantity
2
Hand-held wireless mic
– Auditorium only
2
Wireless lavalier –
Auditorium only
8
Vocal mic
1
16-channel mixer
1
8-channel self-powered
speakers w/ 2 speakers
1 set
Self-powered speakers
w/ built-in CD and mic
inputs
1 set
Single self-powered
speakers w/ mic input
8
Tri-pod mic stands
4
Round-based mic stands
8
Table-top mic stands
1
Portable lectern
1
Flat screen monitors***
5
DVD/VCR deck***
4
Data projectors***
1
Digital presenter***
***
Need assistance
for set-up and break-down only thru-out entire event
Circle only one:
2 hand-held 2 lavaliers 1 hand/1 lavalier
Circle as needed (see map):
Atrium: #1 #2 #3
Student: #1 #2 #3
(shown as stars)
Mic: a b c
Lectern: a b c
Stage lecture
Hand-held wireless (choose one or two areas only):
a b c d e f g h i j k
Sm-58 (depending where, will need wires tacked
down):
a b c d e f g h i j k
Lectern:
a b c d e f
Performances – should request at least two weeks ahead. At least one week prior to performance, a
face-to-face meeting (about 1hr+) is necessary for optimal service. Depending on complexity of set-up,
should be at site 3hrs+ before show time.
Lectures and Recitals – should request two weeks ahead. On day of, please meet on site 1hr+ prior to
event.
If your set-up differs from designated areas already established please use the blank space on
page.
***For video-taping event, contact BCC-AV department (BCC-AV@peralta.edu)
REQUEST FOR A/V SET-UP
Event name: __________________________________________________________________
Presenter: ____________________________________________________________________
Contact email: ________________________________________________________________
Contact number: ( ) _________________________
Event date: ______________________ Time/length: ________________
BCC-AV@peralta.edu
A/V Coordinator phone: (510) 981-2873
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Campus Activity Proposal Form (Berkeley City College)

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Completed 25 July 2020

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