Internal Facility Usage Request Form
(Request by Faculty/Staff for any College Event/Activity)
Employee: Department:
Job Title: Employee ID #:
- Name of Event:
- Purpose of Event:
- Date(s):
- Time(s):
- Campus:
- Facility(s):
- Room #(s):
- Est. Participants: ______ # of Students ______ # of Guests _____ # of Administrators/Faculty/Staff
1. _____ Wi-Fi _____ A/V _____ Screen/Projector _____ Podium Other: _____________________________
2. EQUIPMENT: Tables & Chairs Set-Up, Tent, etc. (specify number of chairs and tables needed and for which locations if more than one area will
be utilized)
3. FOOD SERVICES are subject to prior administrator approval and are the responsibility of the requesting department.
Approval is based on the requesting department’s available funds and purpose.
a. Funds Available: $_______________ Account #: ___________________ Administrator Approval: _____________
b. Purpose (ex. working lunch, refreshments for special guests, etc.): _________________________________________
4. CUSTODIAL: _____ # of Custodians needed to work the event Begin Time ___________ End Time __________
5. OTHER: (Please Specify)
Employee Signature: Date:
Administrator/Supervisor Signature: Date:
****Once approved by your supervisor/administrator, send this form to the appropriate individual
listed below that corresponds with the campus of the event****
GT: Sheila Skelton
MV: Kay Lett
AT: David Lanier
BF: Mark Sloan
BM: Teresa Sutherland
BR: Sharon Morris/Richard Lynn
FH: Mandy Bezeredi
GS: Ed Douglas
TV: Kiki Moore
To have your event added to the College's online calendar or to request media coverage, go to
to complete your request.
Approved by: Date:
Campus Director or Designee
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