Processed By: Date:
1. Organization:
2. Organization Email:
3. Name: Cell Phone: ( )
4. Advisor: Day Phone: ( )
Request must be submitted to Dennis Shannakian, College Life Office
Coordinator, and meet with her to discuss special event.
Request will not be accepted without advisor's approval signature.
Allow at least twelve (12) working days prior to event.
Confirmation of request will be sent to the Club's/Organization's, Submitter's,
and Advisor's email addresses.
As advisor, I approve this activity and will advise the members of their obligation to uphold college rules and regulations, and I will be present
throughout this event, including set-up and clean-up.
5. Purpose of Use:
6. Is any equipment required for this event? q YES q NO If yes, complete a College Life Equipment Checkout Form.
7. q YES q NO If yes, complete a College Life Co-Sponsorship Form.
8. q YES q NO If yes, complete # 7 on a College Life Co-Sponsorship Form.
9. Will money be collected at this event? q YES q NO If yes, complete a College Life Fundraising/Money Collection Form.
10. Estimated Attendance:
13. Facility q Any Room (write description in the comments section)
Date Time Facility
Revised 9/26/2019
11.Day(s) and Date(s) of Use:
(List ALL Day(s) and Date(s))
(Example: Fridays 4/11, 18, 25, 5/2 ...)
Alternate Choice(s) for Day(s) and Date(s):
12. Start Time: AM / PM
Alternate Choice(s):
Advisor's Signature: Date:
• Anyservicerequests(i.e.tables,chairs,canopytents,parkingpermits,electricity,etc.)andfacilityspecicationsshouldbeindicatedhere.
Equipment needs (i.e. PA System, LCD projector, etc.) should be requested using the College Life Equipment Checkout Form on the back.
 
 
Date Time Facility
# of Tables __________
# of Chairs __________
# of Canopy Tents __________
# Parking Permit(s) Required __________
Electricity Required q
Set-up Time: AM / PM To: AM / PM Clean-up Time: AM / PM To: AM / PM
End Time: AM / PM
Complete if Necessary
ForanypotentialstangchargesseeDirect Cost Fees at