Mar2018/tli
LIMITED PUBLIC FORUM REQUEST FORM
Applicant: _____________________________________________________________________
Student: Yes No Community Member: Yes No
Date Requested: ________________________________________________________________
Intended Use: __________________________________________________________________
Hours of Use: __________________________________________________________________
Number of Participants: __________________________________________________________
REQUESTING / RESPONSIBLE PARTY CONTACT INFORMATION
Physical Address: _______________________________________________________________
Contact Person: ________________________________________________________________
Email Address: _________________________________________________________________
Phone / Cell Phone: _____________________________________________________________
Your signature(s) below affirm the guidelines for use of the free speech areas will be followed.
Applicant Signature: _____________________________________________ Date: ________________
For College Use Only Date Application Received: ____________________________________
Columbia College
Vice President, College & Administrative Services
11600 Columbia College Drive
Sonora, CA 95370
Phone: 209-588-5112
