Fillable Office&use&only& Banner!ID!#:! Application*fee:*$25* Please&complete&the&Facilities&Use&Fee&Worksheet&at&the&end&of&this&form&and&submit&along&with&your&application.& See&Facilities&Use&Fee&Schedule&f

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Office&use&only& Banner!ID!#:! Application*fee:*$25* Please&complete&the&Facilities&Use&Fee&Worksheet&at&the&end&of&this&form&and&submit&along&with&your&application.& See&Facilities&Use&Fee&Schedule&for&room,&services,&a nd&equipment&fees .& (Ulster County Community College)

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The Office&use&only& Banner!ID!#:! Application*fee:*$25* Please&complete&the&Facilities&Use&Fee&Worksheet&at&the&end&of&this&form&and&submit&along&with&your&application.& See&Facilities&Use&Fee&Schedule&f form is 3 pages long and contains:

  • 1 signature
  • 36 check-boxes
  • 70 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Ulster County Community College

BROWSE ULSTER COUNTY COMMUNITY COLLEGE FORMS

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!
Version:!1.1.2017!
!"#$%&$'!!!!!! ! ! !!%()*+,-%&./.$.0+,1+0,2))/.&%$."#!
Facilityrental@sunyulster.edu!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!34$05#%/!
!
!
Office&use&only&
Banner!ID!#:!
!
_______________& &
!
Application*fee:*$25*
Please&complete&the&Facilities&Use&Fee&Worksheet&at&the&end&of&this&form&and&submit&along&with&your&application.&
See&Facilities&Use&Fee&Schedule&for&room,&services,&a nd&equipment&fees .&
!
Please!complete!and!return!this!application!to! Facilityrental@sunyulster.edu!%$,/0%+$,67,8%9+,:0;"50!the!
scheduled!event.!A!certificate!of!insurance!must!be!attached!to!your!application.!Final!approval!will!come!in!the!
form!of!an!em a il!from !th e!o ffice!of!the!Vice!President!for!Administrative!Services.!Please!do!not!advertise!your!
event!until!approval!is!official.!!
!
Today’s!date:!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Name!of!organization:!
Contact!person:! ! ! ! ! !Contact!phone:!
Contact!email:! ! ! ! ! !Fax:!!
Organization!address:!
Nonprofit!organization?!!!!!!!!!Yes!!!!!!!!No!!!!If!yes,!tax!exempt!number:!
!
Name!of!event:! !
Description!of!event:!
!
<&=08*/0,";,3>0#$+,
Please!specify!actual!arrival!times,!set-up!and!breakdown/clean-up!times,!
!event!start!and!finish!times,!and!whether!a.m.!or!p.m.!
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Event!open!to:!!!!!!!Public!!!!!!!!!Students!!!!!Staff!!!!!!!!!!Faculty!!!!!!!!!Members!only!
Will!there!be!an!admission!charge?!!!!!!!!Yes!!!!!!!!!No!!!!!If!yes,!how!much?!
!
,
<1FG,1/+$05,.+,%,<("D0@,%#8,2/&"="/@-500,!%()*+,
!
Ulster!reserves!the!right!to!cancel!or!postpone!your!event!depending!on!pandemic!influenza!issues!in!accordance!
with!our!social!distancing!policy.!The!full!policy!is!available!upon!request.
Start Here. Go Far.
PO Box 557
Stone Ridge, NY 12484
845: 687-5000
Fax 845: 687-5083
sunyulster.edu
UNDER THE PROGRAM OF THE STATE UNIVERSITY OF NEW YORK
Ulster County Community College does not discriminate in education, employment or any of its businesses on the basis of sex, sexual orientation, race,
color, age, veteran status, religion, national orientation or handicapping conditions. This policy is in compliance with Title IX of the Education Amendments of 1972.
!
!
!
,,,,,,,,,,,,,,-%&./.$.0+,H0I*0+$08,
!!!!!!%;0$05.%,!
[Max.!capacity !49 5] !
!!!!!-%&*/$9J<$%;;,?.#.#K!!
H""(![Max.!capa city !65 ]!
!
!!!!!L*.(:9,A=0%$50M!!
[Max.!capacity !47 0] !
*Technician!required!(provided!
with!fee)!
!"//0K0,N"*#K0,
!!!!!!Chairs!only![Max.!capacity!185]!
!!!!!!Tables!and!chairs![Max.!capacity!150]!
!/%++5""(+!(room!numbers):!
!
<0#%$0,O9(!
!!!!!!Chairs!only!(no!bleachers)!
[Max.!capacity !19 55 ]!!
!!!!!!Tables!and!chairs!(no!
bleachers)![Max.!capacity!1425]!!
!!!!!!Athletic!event!with!bleachers!!
[950!seating!cap a city !+!1 1!
handicapped!]!!
!
!
<0#%$0,O9(,<$%K0,
!!!!!!Chairs!only![Max.!capacity!150]!
!!!!!!Tables!and!chairs![Max.!capacity!90]!
B"E%58,<$P,Q"=#,<0(.#%5,
H""(,
!!!!!Table!and!chairs![Max.!
capacity!57]!
!
-.0/8+!
!!!!!!Baseball!Field!!!!
!!!!!!Softball!Field!
!!!!!!Soccer!Field!
!!!!!!Tennis!Courts!
!
Number!of!attendees!expected:!!!!!!!!!!!!!!!!!!!!!!!!!!!(Do!not!excee d!maximum!capacity!listed!above.)!
<)0&.;.&,3I*.)(0#$,%#8J"5,<0$@1),H0I*.50(0#$+,R)/0%+0,%$$%&=,8.%K5%(S',
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2*8."T,>.+*%/T,%#8,&"((*#.&%$."#+,0I*.)(0#$,,
,
!!!!!!Sound!!(PA)!!!!!!!!!Lighting!!!
!!!!!!Computer!!!!!!!DVD!!!!!!!!VCR!!!!!!!TV!!!!
!!!!!!LCD!(!personal!laptop)!!!!!!!LCD!(computer!!
provided!by!UCCC)!
!!!!!!Group!Internet!access*!
!
!!!!!!Piano!!(approval!required!from!music!
coordinator):________________________________!
*Internet!access!for!an!individual!computer!is!
available!via!WiFi!connection!on!the!day!of!your!
event.!
<0%$.#K,
!!!!!!!!Number!of!tables!requested!
!!!!!!!!Number!of!chairs!requested!
!
<05>.&0+,,
______!!!!!!!!!!!Table/chair!set-up!and!breakdown!!!!!!!!Housekeeping!!!!!
!!!!!!!Grounds!maintenance!!!!
!!!!!!!!!!!!!!!!!!!!!!!!!Public!safety!!!!!!!!On-site!supervisor!
!!!!!!!Stage!manager!(Quimby)!
!!!!!!!Front-of-house!manager!(Quimby)!
!!!!!!!Registered!Nurse!(subject!to!availability!and!fee)!
Date!and!times!needed:!!!!!!!!!!!!!!!!!!!!!to!
!
Other:!
?.#.#K,+05>.&0+,%50,)5">.808,$=5"*K=,"*5,.#@="*+0,&%$0505,%#8,&%#,:0,%55%#K08,:9,&"#$%&$.#K,Q%+"#,N.0:05K"$,%$,
Q%+"#UN.0:05K" $V +* #9 */+$05P08*,"5,RWXYS,ZW[@Y\[6P!
!]^_N3A3,2F?,<`OF:!!I,!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,!agree!to!(1)!accept!responsibility!for!payment!of!fees!indicated!on!the!
fee!schedule!a nd !fo r!an y!oth e r!cha rge s!resu lting !from !th e!o rga niza tion ’s!use !of!college!facilities,!(2)!promptly!pay!for!any!loss!or!
damage!to!College!property!arising!out!of!or!as!a!result!of!the!organization’s!use!of!these!facilities,!(3)!abide!by!the!rules!and!
regulations!gove rnin g!the !use!o f!the!C olleg e!facilities,!an d!(4)!u nd erstan d!that!any!changes!to!this!request!after!the!approval!has!
been!granted!will!result!in!additional!fees!being!assessed.!!
Final!reservation!for!space!and!facilities!is!not!confirmed!until!applicant!receives!a!copy!of!this!form!signed!by!authorized!personnel.!
! ! ! ! !
Signature,!Department!Head! ! ! ! ! ! Date!
! ! !
!
!
!
Office&U se&On ly&
!
_____________________________________________________! ! _______________________!
Authorized!Signature:!Vice!President!for!Adm inistrative!Services!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Date!
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!
-%&./.$.0+,1+0,-00,a"5D+=00$,
(See&Facilities&Use&Fee&Schedule&for&room,&services,&and&equipment&costs)!
H0#$%/,
-00,
A"$%/,
Administrative!Fee!
$25!
$25!
Facilities!Rental!!
!
!
Technician!(sound/lighting)!
!
!
Other!services!
!
!
Equipment!
!
!
A"$%/,
!
!
!
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Office&use&only& BannerID: Application*fee:*$25* Please&complete&the&Facilities&Use&Fee&Worksheet&at&the&end&of&this&form&and&submit&along&with&your&application.& See&Facilities&Use&Fee&Schedule&for&room,&services,&a nd&equipment&fees .& (Ulster Count

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Completed 21 September 2020

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