Fillable Student Activity Request

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Student Activity Request

On average this form takes 24 minutes to complete

The Student Activity Request form is 2 pages long and contains:

  • 2 signatures
  • 16 check-boxes
  • 79 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Cuesta College

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SLL Date Stamp Here
OFFICE USE
Request #
Permit #
Service #
Cuesta College Student Life and Leadership
STUDENT ACTIVITY REQUEST
PLEASE PRINT
IN
BLUE/BLACK IN
K
Request for approval should be made AT
LEAST TWO WEEKS
in advance.
Today’s date Event Title
Club
/O
r
ganization
Name
Requestor’s Name
Requestor Phone Requestor E
m
ail
Club
Advi
sor
P
hon
e/Ext.
Club
Advi
sor
E
m
ail add
ress
Club
Advi
sor
Dept.
Event
Details
Event Starts: at am/pm* Event Ends: at am/pm*
Day & Date
Setup time am/pm
Day & Date
Tear Down am/pm
*_ Club Advisor Signature Agreeing to Attend Event
On-Campus Events outside normal business hours (8a-5p Mon-Thurs, and after 4:00 on Fri.) and all off-campus events require the Club
Advisor’s attendance.
San Luis Obispo campus North County campus Off campus Location
Location Room #
Location_______________Room #
Location_________________________
Please
briefly describe your activity
,
including all pertinent details. Attach a drawing and/or separate piece of paper if
more
room
is
needed:_
Please check box(es) and
fill
out
or
attach form
for all
that
apply:
Publicity Tool Request form Request for Service/Tech/AV Equipment form (Back)
Is
this
a fundraiser? No Yes
If
yes
,
state the purpose for which the funds are being
raised, the method of raising money, and the charge/fee.
Be
specific.
``
Is this a food event? No Yes (*information required)
If
yes,
is
there
a
charge?
No
Yes
If yes
$
*Name of Vendor
*Food Served
R
E
QU
I
RE
D
S
IG
NAT
URE
S
Signature
–
Student
Coordinator Date
Signature
–
Club
or
Organization Advisor/Sponsor
or
Division
Chair Date
F
O
R
O
FF
IC
E
US
E
O
NLY
Request for the following submitted:
Facility Use Permit (permit # ) Publicity Form submitted
Request for Service/Tech/AV Equip form (request # )
Signature & Date – Coordinator, Student Life and Leadership
Original retained by Student Life and Leadership Copy to Requestor Copy to Club Advisor
Copy to Activities Director/Clubs Director Copy to Public Safety
click to sign
signature
click to edit
click to sign
signature
click to edit
REQUEST FOR SERVICE/TECHNOLOGY/AV EQUIPMENT
FOR EVENT LISTED ON FRONT PAGE
Request for approval should be made
AT
LEAST TWO WEEKS
in advance.
PLEASE PRINT
IN
BLUE/BLACK IN
K
E
ve
nt Title E
ve
nt Date
Estimated # of people ________
# Tab
les
#
of
Ch
ai
rs
AudioVisual and Special Equipment Request
User
i
s
responsi
ble for
safet
y and
securit
y of all
eq
ui
pment.
Set ups are subject
t
o
avai
labil
ity and personnel.
#
#
#
White Board
PA System w/ wireless mi-
crophone (5401)
Speaker, Additional w/
Stand
CD Boom Box
PA System Anchor w/ Stand
Speaker, Advanced Pow-
ered for Laptops
Camcorder
Polycom
TV/VCR Combo
Cassette Record
Polycom w/ Content Sharing
NCC-SLO
Tripod
Extension Cord
Polycom w/ Content Sharing
SLO-NCC
VHS Recorder
DVD/VCR Player
Projector, 35mm Slide w/
Tray
Easel (no pad)
Laptop Computer
Data Projector
Podium
Microphone Stand
Overhead Projector
Microphone, Standard
Screen, Projection
(portable)
Additional
requested
items
may
be
listed
here:
If necessary, provide a drawing for room setup or attach a separate paper if more room is needed.
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Student Activity Request

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Completed 6 March 2020

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