Facilities Request Form (on campus organization) Note: Submitting this form electronically will provide an e-signature. Student Organizations Note: The form needs the signature of the Student Activity Coordinator before we can process; therefore, we will printout and send the form for signing. Lists of Rooms Reserved Reservations by Date Reservations by Organization Auditorium Reservations Student Organization?*Is this for a student organization?NoYesAre you requesting Wieden Auditorium?*NoYesSponsored event?*Are you sponsoring an outside organization?NoYesNOTE: There is a $1.00 per person fee for sponsored events.Who from your department will be in attendance at this event?*Who is responsible for any additional costs?*UMPI DepartmentOff Campus OrganizationWhich Department?*(responsible for additional costs)Are UMPI Students participating in this event?*YesNoSponsor Information*Please enter Billing Organization, Name, Address, Phone, and Email for the sponsor of this event. Fundraiser?*Is this a fundraiser?NoYesYour Information / Contact Person's InformationUniversity Account NumberName*Phone*Email* Department or Organization Name*Please use the name of the department you work for or your student organization, not the name of a committee.Contact NameName of person who will attend the event and act as the contact personContact PhoneMailing Address*Enter your mailing address or campus mailbox. If you're a student, enter an address where we can send a confirmation.Event InformationEvent 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. When available, ticket prices should be included since this information will be included in the University calendar.Facility (or facilities) requested*Name of the facility you are requesting or your general need (e.g. classroom to seat 30 people.) If you require the use of several facilities on campus, each facility should have a separate reservation form if the times vary.Day(s) and Date(s) of event*Please include day and date (i.e., Tuesday, January 10, 2017). This form may be used to reserve several days at one time provided that the use is for the same purpose and time each day. CONTINUOUS REQUESTS: Please let us know if you will meet during school breaks.Time In*Time you wish to enter the facility : HH MM AM PM Start time of event* : HH MM AM PM Time Out*Time you wish to relinquish use of the requested facility : HH MM AM PM Who may attend?Admission FeeAnticipated Attendance*The number of people you are expecting to attend or to participate at your event. Please be as accurate as possible.Special Accommodations / Setup Instructions / Requirements / PublicityIf your organization needs a stage, equipment moved from building to building or outdoor signage, the Facilities Work Order Request must be submitted. A link to the Facilities Work Order Request Form will be provided again once you submit this form. Please check any that apply Special accommodations Audio / Visual / Technology Needs Non-students expecting to use campus computers Special setup instructions Food Service Special AccommodationsIf any of your attendees require special accommodation, please describe here.Audio/Visual or Technology NeedsIf technology is required, please describe here.Special setup instructionsIf you have any special setup instructions, please describe here.Special setup for Facilities ManagementIf you need special setup for Facilities Management, please describe here.Computer Accounts After this form is submitted, you will be given a link to a form to request non-academic computer accounts.Food Service from Sodexo After this form is submitted, you will be given a link to Dining Services.List event in the Image?*Would you like to list your event in the Image Newsletter?NoYes This iframe contains the logic required to handle Ajax powered Gravity Forms.