Box 398, Poplar, MT 59255
Administration (406) 768-6300
Fax (406) 768-6301
www. fpcc.edu
INVOICE
#
F
A
C
I
L
I
T
Y
USE FORM
(PLEASE
P
R
I
N
T
)
The College serves the people by initiating and supporting community activities and organizations based on the needs
and wishes of community members, which promote the social education and
w
e
ll-
being of the Fort Peck Indian
community.
Date of
Function:
________________________ Purpose
for
request:
_______________________
Time
of Function:
________________________
# of people expected:
______________________
Building Requested:
______________________ Purchase
Order
#:
__Classroom
#______
Equipment needed:
__
Community Room
__
Phone
__
Kitchen
__
Projector/Screen
__Foyer __TV/DVD
__
Auditorium __CEU’s
Name of Person or Group requesting use (responsible party, billing information); If a
s
t
u
d
en
t
organization the
form must be signed by BOTH the faculty/staff advisor and the student
g
r
o
u
p
president and must be approved of
prior to scheduling room use.
Organization:
_____________________________ Phone:
____________________________________
Name: ___________________________________ Email:
____________________________________
Mailing
Address:
__________________________
City/Zip:
__________________________________
Signature:
________________________________
Date:
_____________________________________
Approved
by:
_____________________________
Date:
_____________________________________
Return completed form to Poplar Campus or Wolf Point
Ca
m
p
u
s
Two (2) weeks prior to event. Forms may also be emailed
t
o
:
Debra Granbois (dgranbois@fpcc.
edu),
Poplar (406)
768-6300
o
r
Ember Runs Through
(erunsthrough@fpcc.edu),
Wolf Point (406) 653
-
3900
WARNING: Failure to clean up after your event could
affect
future use of college
f
a
c
ili
t
i
e
s
.
Disclaimer – FPCC is not responsible for accidents, thefts, injuries or other criminal activity, which
may occur during the proposed use of the facilities described on this form.
PAYMENT MUST BE PAID IN FULL PRIOR TO USAGE OF ANY FPCC B
U
I
L
D
I
N
G
FPCC RESERVES THE RIGHT TO RUFUSE OR DENY THE USE OF ANY
FA
C
I
L
I
T
Y
.
Mon-Friday Friday
e
v
en
i
n
g
-
S
un
da
y
$125.00 $250.00
Make all checks payable to:
Fort
Peck
Community
C
ollege
