Fillable Facility Use Request Multiple LHC NCK NMC BHC (Mohave Community College)

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Facility Use Request Multiple LHC NCK NMC BHC (Mohave Community College)

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Facility Use Request
MCC Form ADM 0006 (rev 12/19/19)
BHC
LHC
NCK NMC
Multiple
Event Date/Days
Event Name
Requesting Organization/Department
Event Start Time Event End Time
Arrival Time Departure Time
# Attendees
Fee Schedule
Point of Contact Name
P
oint of Contact Phone Number
Point of Contact Email Address
Type of Facility Requested
Facility Assigned (for office use only)
Room # if known
Eve
nt Description:
Requested Room Set-Up:
Minors?
Food?
Requested Equipment:
Presenter Podium (computer & projection)
Television or Monitor
DVD Player, VCR
Microphone/Speakers
Whiteboard(s)
Conferencing (Video/Audio)
Stage
Overh
ead Projector
*a small fee may be assessed for items or services (technicians) outside of normal business hours
(For office use only) Prepared/Reviewed by: ____________________
Approved: (Signature)
____________________________________________
Dean of Student & Community Engagement
Requester: (Signature)
________________________________
I: MCC or College Affiliate
Select One
Other (attach diagram separately)
No
Select
Other
Date:
Date:
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Facility Use Request Multiple LHC NCK NMC BHC (Mohave Community College)

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Completed 2 February 2021

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