Public Affairs Use
Staff Assigned: _____________
Due Date: _________________
Public Affairs Project/ Special Event Request
Originator: ____________________________________________________________________________
Division: ___________________________ Extension #: ______________ Date of Request: ____________
Purpose: ____________________________________________ Contact: ___________________________
Publications/ Project: __________________________________________________________________________
Quantity: _______________________________________ Color Preference: _______________
/ Proofed by Originator: ___________________________________________________________
Business Cards Special Instructions: ______________________________________________________________
Account Number __________________________________________________________________________________
_________________
A minimum of ten (10) working days for requests is required.
Advertising Purpose: _________________________________________________________________________
Where to be Utilized: _____________________________________________________________
Account Number
Date to be Run: __________________________________________________________________
_________________
Special Instructions: ______________________________________________________________
__________________________________________________________________________________
Special Event Purpose: _________________________________________________________________________
Description: ____________________________________________________________________
Account Number
Date of Event/Place/Time:_________________________________________________________
_________________
Special Instructions: ______________________________________________________________
G.C. Representatives to Attend:___________________________________________
Contact Person: _______________________________________________________
A minimum of ten (10) working days for special events is required.
Check list: ______ Did you request media exposure in section above?
______ Did you fill out a Facility Service Request form for setup?
______ Did you route for all appropriate signatures?
______ Did you indicate what account would be charged?
Media Purpose: _________________________________________________________________________
Copy of Information Attached: __________________________________________________
Photo Requested: (Date/Time/Place) ____________________________________________
Must be run on or before: ________________________________________________________
Special Instructions: ______________________________________________________________
__________________________________________________________________________________
The Public Affairs staff agrees to fulfill the above requested project(s) for completion by the promised date. The originator agrees to provide accurate infor-
mation in a timely manner and takes responsibility for proofing all publication requests and other assignments as mutually agreed upon in the special instructions
portion of this form. All special events require a security signature and approval of the Vice President of Administration.
______________________________________ _____________________________________ ______________________________________
Originator’s Signature /Date Supervisor’s Signature/Date Vice President
______________________________________ _____________________________________
Director of Facilities/Security Director of Public Affairs
______________________________________
Vice President of Administration
(for Special Events)
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