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Version:!1.1.2017!
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Facilityrental@sunyulster.edu!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!34$05#%/!
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Office&use&only&
Banner!ID!#:!
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_______________& &
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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:!
!
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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/+$05,.+,%,<("D0@,%#8,2/&"="/@-500,!%()*+,
!
Ulster!reserves!the!right!to!cancel!or!postpone!your!event!depending!on!pandemic!influenza!issues!in!accordance!
with!our!social!distancing!policy.!The!full!policy!is!available!upon!request.
Start Here. Go Far.
PO Box 557
Stone Ridge, NY 12484
845: 687-5000
Fax 845: 687-5083
sunyulster.edu
UNDER THE PROGRAM OF THE STATE UNIVERSITY OF NEW YORK
Ulster County Community College does not discriminate in education, employment or any of its businesses on the basis of sex, sexual orientation, race,
color, age, veteran status, religion, national orientation or handicapping conditions. This policy is in compliance with Title IX of the Education Amendments of 1972.
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,,,,,,,,,,,,,,-%&./.$.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!
! ! !
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Office&U se&On ly&
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_____________________________________________________! ! _______________________!
Authorized!Signature:!Vice!President!for!Adm inistrative!Services!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Date!
click to sign
signature
click to edit
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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!
$25!
Facilities!Rental!!
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Technician!(sound/lighting)!
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Other!services!
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Equipment!
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A"$%/,
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