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.

Student Organization?*
Is this for a student organization?
Sponsored event?*
Are you sponsoring an outside organization?
NOTE: There is a $0.50 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 Department
- Off Campus Organization
Which Department?*
(responsible for additional costs)
Are UMPI Students participating in this event?*
Sponsor Information*
Please enter Billing Organization, Name, Address, Phone, and Email for the sponsor of this event.
Fundraiser?*
Is this a fundraiser?
Your Information / Contact Person's Information
University Account Number
Name*
Phone*
Email*
Organization Name
Contact Name
Name of person who will attend the event and act as the contact person
Contact Phone
Mailing Address*
Enter your mailing address or campus mailbox. If you're a student, enter an address where we can send a confirmation.
Event Information
Event 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*
Date(s) of event*
Time In*
: HH
MM
Time you wish to enter the facility
Start time of event*
: HH
MM
Time Out*
: HH
MM
Time you wish to relinquish use of the requested facility
Who may attend?
Admission Fee
Anticipated 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 / Publicity
Please check any that apply
- Special accommodations
- Audio / Visual / Technology Needs
- Non-students expecting to use campus computers
- Special setup instructions
- Special setup for physical plant
- Food Service from ARAMARK
Special Accommodations
If any of your attendees require special accommodation, please describe here.
Audio/Visual or Technology Needs
If technology is required, please describe here.
Special setup instructions
If you have any special setup instructions, please describe here.
Special setup for Physical Plant
If you need special setup for Physical Plant, 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 ARAMARK
After this form is submitted, you will be given links to CaterTrax for food service.
List event in the Image?*
Would you like to list your event in the Image Newsletter?

Facilities Request Form (on campus organization)

Your Information / Contact Person's Information

Event Information

Special Accommodations / Setup Instructions / Requirements / Publicity