1. Today’s Date.
2. Day/Date of Event. Please include both day and date (i.e. Saturday, January 23, 1993)
This form may be used to reserve several days at one time provided that:
a. The use is for the same purpose and time each day.
b. No support services are required on any of the requested days (i.e. police, food,
custodial, air-conditioning, etc.)
3. Time In. Time you wish to enter the facility.
4. Time Out. Time you expect to relinquish use of the requested facility.
5. Event. Time of event’s start if different from the time in.
6. Anticipated Attendance. The number of people you are expecting to attend or to participate at your
event. Please be accurate as this figure is used for the assigning of all overtime personnel.
7. Facility. Name of the building you are requesting. If you require the use of several facilities on
campus, a separate Facilities Usage Form should be prepared for each facility.
8. Room Number(s). Example: Engleman 135
9. University Organization or Outside Organization. Check the appropriate box. All outside users
must contract with SCSU for the use of facilities.
10. Organization Name. Full name of organization. No acronyms, please.
11. Name of Contact Person. Complete address and telephone number should be included
12. Event Description. Description of your planned use of the facility. In the case of a performance or
presentation, please be specific about the title, groups or individuals being presented.
14. Admission or Registration Charges: If yes, indicate the amount.
16. Alcoholic Beverages. Events where alcohol is sold or distributed require adhering to specific
University policies available from the Facility Administrator.
17. Food Service. As indicated, food service must be ordered through the University concessionaire for
most facilities. Food cannot be sold or distributed on campus by independent contractors or individuals.
18. Fund/Account to be Charged. Indicate the University account where charges must be coded. (i.e.
General, Auxiliary, Extension, Student Activity, etc.) .
19. Audio Visual/Television Services. Be specific in your needs. The Facility Administrator will
forward your request for these materials to the AV/TV Office. Leave blank if you contact the AV/TV Office
20. Special Instructions. Indicate all special arrangements for the event (i.e. podium, chalkboard, room
21. Faculty Advisors. Name, Address and telephone number should be included.