Processed By: Date:
1. Organization:
2. Organization Email:
3. Name: Cell Phone: ( )
Email:
4. Advisor: Day Phone: ( )
Email:
•
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.
INFORMATION
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.
ADVISOR APPROVAL
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
OFFICE USE ONLY
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
COMMENTS
Alternate Choice(s):
15.
Advisor's Signature: Date:
14.
• Anyservicerequests(i.e.tables,chairs,canopytents,parkingpermits,electricity,etc.)andfacilityspecicationsshouldbeindicatedhere.
• 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
ForanypotentialstangchargesseeDirect Cost Fees at https://www.deanza.edu/facilities/facilityrentalfees.html
collegelife@fhda.edu
408-864-8756
www.deanza.edu/collegelife
