SB ADMIN-110 APPLICATION FOR THIRD PARTY USE OF COURT FACILITIES Page 1 of 2
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO
APPLICATION FOR THIRD PARTY USE OF COURT FACILITIES
INSTRUCTIONS: Save, attach, and submit this form via email to: desmith@sb-court.org. This email address can only
be used to submit this form; any other correspondence will not be processed. Or return completed application to the
San Bernardino Superior Court Executive Office 247 W. Third Street, 11
th
Floor, San Bernardino, CA 92415. Attach
additional pages if necessary and all supporting documentation. Submit at 30 days in advance of the desired date of
use. See Policy for Third Party Use of Court Facilities for additional information.
1. Contact person:
Phone number:
Email:
Fax number:
2. Organization name:
Phone number:
Email:
Fax Number:
Organization address:
Type of organization:
If the organization has a court employee contact, please answer the following:
Employee name:
Phone Number:
Job title:
Court Location:
3. Court location requested: Barstow Fontana Joshua Tree Juvenile Delinquency
Juvenile Dependency Rancho Cucamonga San Bernardino Child Support
San Bernardino Historic San Bernardino Justice Center Victorville
Other (Explain):
Number of conference rooms requested:
Number of courtrooms requested:
Will the number of rooms needed change for each day of this request? No Yes (If the number of rooms
needed is different for each day of this request, attach a sheet of paper listing each date and the requested number of
rooms.)
Is the Jury Room requested: No Yes If “yes,” time: (from) a.m./p.m. (to) a.m./p.m.
Any other area of the court requested:
Date(s) / Time(s) requested (complete a new form for each month, but if recurring, see below):
Date:
Time (from):
a.m./p.m. (to):
a.m./p.m.
Date:
Time (from):
a.m./p.m. (to):
a.m./p.m.
Date:
Time (from):
a.m./p.m. (to):
a.m./p.m.
Is this request recurring? No Yes If “yes,” please explain:
SB ADMIN-110 APPLICATION FOR THIRD PARTY USE OF COURT FACILITIES Page 2 of 2
4. Expected number of participants:
Describe the intended use of the facility:
Date:
Electronic printed signature
EXECUTIVE OFFICE USE ONLY
Date Received / Initials: /
Request for use of facilities is: Denied Granted Granted with modifications or restrictions listed below:
Availability of requested room(s)/courtrooms) to be determined.
Date:
Electronic printed signature
Comments:
Requestor to be responsible for any damage, all clean up, and returning room to original configuration.
Court employees:
Non-court employees:
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signature
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