EVENTS ON CAMPUS, FACILITIES ACTION SHEET (FAS)
Winter Haven Campus/JD Alexander Center
Choose one of the options below:
This facility has already been reserved for this event.
PLEASE RESERVE THIS FACILITY NOW, IF POSSIBLE.
Name of Event:
Date needed: Starting time:
to:
Open area(s) from:
AM PM AM PM
Sponsoring Organization:
Phone:
Phone:
Person in Charge:
Fax:
Email:
WST (126) WHC (GYM) JDA FA Lobby Other
Building/Room/Courtyard:
This section serves as a work order for the Facilities Department. At least 10 days before the event, please contact Facilities: Keith Smith at
ksmith@polk.edu or Susan Ewing at sewing@polk.edu or x5059 or 863-297-1059, to schedule a site visit and discuss set-up for your event.
Please use a diagram for simple setups and to show the location of any lecterns, chairs, and tables. See room layouts attached to this form.
Set-up date: Time:
Lecterns
#:
Chairs
Other:
Round Tables
Event Parking SignsRectangular Tables
Extension Cords
Custodial
Parking Lot Lights: On:
Large Wastebasket
Off:
This section serves as a work order for Media Technology Services. At least 10 days before the event, please contact Media Technology Services at x5288 or
863-292-3685 or avservicesgroup@polk.edu to schedule a walkthrough to discuss technical and specialized needs for your event.
Video Projector
Screen
Computer
Internet Access (subject to availability at location)
Conference Phone (Polk State College Employees Only)
Portable PA
Building Supervisor:
Date Received: Date Distributed:
Distribution: Cultural Events #22; Facilities/Security #18; Media Technology Services #3; Provost #26; Student Services #23
Instructions: Complete a Facilities Action
Sheet (FAS) for each event that requires set-up
(including rehearsals). This form confirms your
reservation of space and notifies all service
departments of area set-up, equipment and
media needs. For questions on filling out this
form, call the Cultural Events Office at x5050
or 863-297-1050.
Note: This form is due in the Facilities Office
ten (10) days before the event. When
complete, use the "Email Form" button.
Capacity:Building/Room:
Breakdown Date: Time:
#:
#:
#:
(WST only, limited quantity)
#: Length:
Special Parking:
Reserved Handicap Parking Map
WHC Gym Only (Check all that apply):
Pullout StageBleachers - Upstairs/DownstairsRamps
Other:
Cultural Events Office Use Only:
Electronic Typed Signature:
Title:
Date:
Microphones:
Lapel
Wired
Cordless
#:
#:
#:
Other:
Time:Scheduled Site Visit Date:
Time:Scheduled Site Visit Date:
Other Instructions:
