_______________________________________________________________
Director or Assistant Director of Student Engagement Date
Coahoma Community College
Division of Student Engagement
Office use only!
Date submitted:
Student Activities Form
PLEASE NOTE:
•
The college reserves the right to cancel a reservation for special and/or unforeseen circumstances, although every
effort will be made to honor scheduling.
•
A permit will be issued when approval for the event is granted.
•
To avoid any delays in processing and receiving approval for your program, complete each line as
indicated.
•
Incomplete forms will not be processed.
•
All forms must be submitted to the Division of Student Engagement at least two weeks prior to the event. Any
forms submitted after this time may not be scheduled due to improper notice.
•
ACTIVITIES ARE NOT TO BE HELD DURING THE LAST TWO WEEKS OF A SEMESTER!
Requestor
Information
Name of Organization requesting space/activity Name of person requesting space/activity
Requestor’s phone number email address
Advisor’s Name extension email address
Name of facility requested (1
st
Choice) (2
nd
Choice)
Any room reservation that exceeds the normal business or operating hours of the facility will require Coahoma Community College
Campus Police present.
Date of event/ activity/solicitation (1
st
choice) (2
nd
choice)
Event starting time Event ending time
The event start time and end time should include time to set up and breakdown the event. Decorating will only be allowed the day of
the event unless otherwise authorized with facility director.
Event title
Expected Attendance (Number) Expected Audience
Please
describe
your
event
in
detail
(use
attachment
if
necessary):
Type of event:
meeting
guest speaker
presentation
dance/party
experience event
reception/banquet
other (please describe)
Will money be collected for this event?
yes
no How?
Who will collect the revenue?
Will campus police be needed for this event?
yes no
Signatures
Unit Dean or Director Date Club/Organization Advisor Date
Student Activities Coordinator Date
Director of Campus Safety Date
click to sign
signature
click to edit
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