NORTH CAROLINA AGRICULTURAL AND TECHNICAL STATE UNIVERSITY
POLICE & PUBLIC SAFE
TY
Event Security Request Form
Department/Organization Requesting Service:______________________________________________
Name of Event: ________________________________________________________________________
Service Requested:
Athletic Event:____________________
Parade Escort
Personal Security
Social (Parties, Concerts, Receptions)
Vehicular/Pedestrian Traffic
Student Activity
Gym Jam
Educational (Seminars, Forums, Speakers,Conferences)
VIP Transportation
Other (Demonstrations, Special Visitors, Etc.)
Beginning Date of Event:_____________
Beginning Time of Event: ____________
Ending Time of Event:______________
Event Location:________________________________________ Room #:____________________________
Expected Attendance:____________
Contact/Responsible Person:__________________________________Work Number:___________________
Email Address:_____________________________________________ Cell Phone: ____________________
FAX Number: ____________________________
Ending Date of Event:_______________
Event Details:
Sales at Door
Pre-Sold Tickets
Open to Public DJ
Student Fundraiser
Alcohol Distribution
Arm Bands
Other:_______________
Additional/Special Instructions (limited to 500 words):
___________________________________________________________________________________________
___________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Form RFS-1
Revised 10/18
Payment Method:
Purchase Order Number_______________________
Fund Account Number___________________________
Acct # (7
+ Object code):______________ Org. Code: __________ Prog. Code: __________
_______________________________
Print Name
**Note: A Fund or PO number must be submitted before any services are provided. **
For further information or quotes, please contact:
Lieutenant Bobby Cuthbertson (336) 334-7128 or
(bcuthbertson@ncat.edu)
Major Kelly White (336) 334-7230 or (ktwhite@ncat.edu)
Requests for services must be made ten business days in advance and cancellations must
be made 48 hours in advance. The number of officers required will be determined based
on the nature and size of the event.
Security Requested [number of person(s) needed]: Unarmed ____________________
Police Officers requested [number of officer(s) needed]: ________________________
Parking Services Officers Requested [number of officer(s) needed] ______________
_____________________________
Signature
__________
Date
____________________________________________
FOR UNIVERSITY POLICE DEPARTMENT USE ONLY
Approved by :_
________________________________ _____________________________ ________________
Authorized Deparment Person Signature Date
Check
Please complete payment information or check the payment method for this event below, all fees will be received by
University Police Department following your event.
Credit/Debit
Cash
click to sign
signature
click to edit
click to sign
signature
click to edit
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