Orange County Community College
Central Scheduling Office
115 South Street
Middletown, New York 10940
Phone: (845) 341-4720 Fax: (845) 341-4721
APPLICATION FOR USE
OF FACILITIES BY
OUTSIDE ORGANIZATION
Event Date:
Name of Organization: __________________________________________________________
Billing Address: ________________________________________________________________
Name of Applicant: _____________________________________________________________
Name of Contact Person: ________________________________________________________
Telephone: (Day) _________________________ (Evening) _____________________________
Facility Requested: _____________________________________________________________
Title of Event: __________________________________________________________________
Date (s) of Event: _______________________________________________________________
Description of Event: _____________________________________________________________
Hours Requested for Facility: _______________ Time of Event: ___________________________
Supervisor of Event: _______________________Sponsor of Event: _______________________
Approximate Attendance: __________ Special Needs? _________________________________
(If you need any special set up, please include a floor plan.)
Will event be open to the general public? ______ (Y/N) Admission cost? $_________________
If admission is charged, how will the proceeds be used? ________________________________
Will you be using food services? ________ (Y/N) If Yes, contact Bob Glohs, Food Service Manager at (845)
341-4862, prior to submitting application. Our Food Service Department has first refusal of service
rights.
Who is your Insurance Agent? ______________________________________________________
Please provide a certificate of your insurance coverage which lists Orange County Community College
as an additional insured. Our requirements are for a general liability of three million dollars. This
certificate of insurance is essential to complete this application.
In case of any illness and/or injury to any participant, please notify the Safety/Security office by calling
(845) 341-4710 and/or the campus nurse at (845) 341-4870.
All advertisements, promotions, and/or publications regarding this event must be approved by Vincent
Cazzetta, Vice President of Institutional Advancement, (845) 341-4726.
Your group will accept full responsibility for ticket sales/distribution, and publicity.
Please read policy statements on the reverse side and sign the application before returning it to the
Central Scheduling Office. Application must be submitted at least thirty (30) working days before the
event. If the form is not completed properly, (i.e. special needs not listed), your reservation may be
affected.
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