Fillable MEMORANDUM TO: Off-Campus Groups (LSU Eunice)

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MEMORANDUM TO: Off-Campus Groups (LSU Eunice)

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The Chancellor
LOUISIANA STATE UNIVERSITY EUNICE | PO Box 1129 | EUNICE, LA 70535
337-550-1222 | Fax: 337-546-6620
MEMORANDUM TO: Off-Campus Groups
FROM: Patricia Spears
Administrative Coordinator 2
Request forms for use of LSU Eunice facilities and premises should be submitted to the
Chancellor's Office at least two (2) weeks in advance of the scheduled event.
A certificate of liability insurance indicating the amount of insurance coverage should accompany
the completed form. The amount of insurance coverage required is as follows:
Non-athletic events -- $ 300,000
Athletic events -------- $ 1,000,000
The form cannot be approved or processed until the Certificate of Insurance has been received.
We advise you not to publicize any information about holding an event at LSU Eunice until you
have received your approved copy from us. To indicate our approval, a copy of the signed form
will be mailed to you.
The Chancellor
LOUISIANA STATE UNIVERSITY EUNICE | PO Box 1129 | EUNICE, LA 70535
337-550-1222 | Fax: 337-546-6620
(Off-campus groups must complete this form)
LSU EUNICE AFFIRMATIVE ACTION/EQUAL OPPORTUNITY POLICY
Louisiana State University Eunice adheres to the principle of equal education, employment and
promotion opportunity without regard to race, creed, color, national origin, sex, age, handicap,
or veteran’s status. The University is dedicated to the philosophy of providing opportunity for
full participation and representation in all segments of its operation to every individual who
possesses the required training and experience.
The University will provide equal opportunity for all qualified and qualifiable persons, and will
promote the realization of equal opportunity through positive, continuing training programs in
all applicable departments.
----------------------------------------------------------------------------------------------------------------------------
___________________________________________________________________recognizes
the LSU Eunice commitment to affirmative action/equal opportunity. Further, it recognizes that
LSU Eunice is a state-operated institution.
___________________________________________________________________does not
discriminate in its membership, employment, activities, or in any other facets of its operation
of the basis of race, creed, color, national origin, sex, age, handicap, or veteran’s status.
________________________________ ___________________________
Officer’s Signature/Title Date
________________________________ ___________________________
Witness Date
Request for Use of LSU Eunice Pool
P. O. Box 1129 • Eunice, LA 70535
Phone: (337) 550-1395 • Fax: (337) 546-226
*Requests should be submitted at least two weeks in advance.
IMPORTANT: Certified lifeguards approved by the university are required to be on duty at all
times when the pool is in use. Please complete and attach this form to the “Request for Use of
LSU Eunice Facilities and Premises.” You will be notified of the university’s ability to
accommodate your request.
Name of Group or Organization: ____________________________________________________
Contact Person:__________________________________________________________________
Phone Number:________________________ Email:_______________________________
Number of Adults Swimming (Age 18 and over) ______
Number of Children Swimming (Ages 13 – 17) ______
Number of Children Swimming (Ages 9 – 12) ______
Number of Children Swimming (Ages 0 – 8) ______
Number of adult Supervisors accompanying children ______
TOTAL Number of People Who Will be Swimming ______
********************************************************************************
For Office Use Only
____ Approved ____ Approved w/Conditions ____ Denied w/Explanation
Conditions/Explanation: ___________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
___________________________________________________ __________________________
Coordinator of Student Activities Date
0
Organization Sponsoring Event:
Name of Event:
Date(s): Exact time of event: from
to
Additional Times Needed (rehearsal, setup, etc.): Arrival time:
Contact Person: Email:
Address:
Street City State Zip
Phone Number: Fax Number:
Person to Invoice: Email:
If different from above
Address:
Street City State Zip
Phone Number: Fax Number:
Room:
Gym Pool Conference room Computer Lab
North or South Commons
Video Conference Science Auditorium Conference center
Health Tech Auditorium Community Ed Auditorium
Classroom
If you have a specific room(s), please indicate the room(s)
What is the anticipated attendance? Is activity open to the general public?
Will an admission be charged? If yes, how much per person?
Is any special equipment (smart cart, projector, etc.) or set up (platform, table/chair arrangements) required?
_________ If yes, please indicate type below. (You may attach a diagram)
_________ If sound system is needed, you must contact Dr. Jackson at 550-1395 at least one week before event
_________ If Health Tech Auditorium is needed, Contact Dr. Baltakis at 550-1326 at least one week before event
Are visitor parking permits needed? _______________ If yes, how many? _____________________________
Regulations governing the use of LSU Eunice facilities:
1. Off campus users will be required to reimburse the University for the cost of utilities, catering, janitorial, and security services,
lifeguard pay, and any other direct costs.
2. The user(s) of University facilities or premises will not hold the University or any of its employees responsible for any accidents,
bodily injury, or damage occurring in the preparation of, during, or after the use of facilities. Off-campus groups must submit proof
of adequate liability insurance ($300,000 for non-athletic events or $1,000,000 for athletic events)
LSU Eunice reserves the right to increase limits.
3. Facilities/premises must be left in the same condition as previously existed, and the user(s) must accept responsibility
for any damages occurring during the use of University property.
4. LSU Eunice reserves the right to refuse any request for use of its facilities/premises.
5. Pool use: 1 adult/10 children or 1 adult/6 children (below 3rd grade).
6. LSUE is a tabacco free campus. The use of tabacco products is prohibited.
Vice Chancellor for Enrollment Management (for student groups only) Signature of Individual Requesting Use of Facility
Chancellor's Office (for reservation of facilities) Vice Chancellor for Business Affairs
Facility Cost:
Cc: Business Affairs/ Physical Plant/Student Affairs/ Academic Affairs/Campus Police Rev. July 2017
Request for Use of LSU Eunice Facilities and Premises
*Requests should be submitted at least two weeks in advance
.
P. O. Box 1129 • Eunice, LA 70535
Phone: (337) 550-1222 • Fax: (337) 546-6620
Jed Joubert - Director
Chartwells/LSUE
jed.joubert@compass-usa.com
ORGANIZATION: CONTRACT#:
CONTACT PERSON: DATE OF EVENT:
ADDRESS: BUILDING:
ROOM:
GUEST COUNT:
E-MAIL: TIMES
PHONE: SET-UP:
FAX: SERVICE:
EVENT BEGINS:
EVENT ENDS:
QUANTITY TOTAL
PLATES: paper plastic china ceramic
GLASSES: paper plastic glass
UTENSILS: silver plastic
LINENS: paper cloth
DRINKS: water tea soda
coffee
CLIENT SIGNATURE: DATE:
MENU
Office: 337-550-1280
Cell: 318-664-0684
PRICE/ITEM
ITEM
Unless noted, plastic will be served
Tablecloths wil be placed on food tables only unless requested otherwise.
INVOICE SUBTOTAL
FLORAL
ATTENDANT FEE
ALL INVOICES MUST BE PAID IN 30 DAYS.
Please sign contract only when satified with finialization. Outside organizations must
present checks within 30 days after the scheduled event has occurred.
Please review methods of payment for correct billing procedures, and call within 24
hours of receipt of this contract. Guests count must be guarnteed 72 hours in
advance. Any charges made after the receipt of this contract may be subject to
additional charges. Left over food items are the property of the purchaser. A
replacement fee may be applied to all rentals for at the conclusion of the event.
Cancellation less than 72 hours of the event may result in a 10% surcharge of the
contract.
SETUP NOTES
LINEN FEE
CHINA FEE
CHANGE FEE
AFTER HOURS
TAX
TOTAL DUE
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
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MEMORANDUM TO: Off-Campus Groups (LSU Eunice)

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Completed 20 January 2021

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