Student Activities Office
Appendix D UVI Student Activities: Revised Summer 2013 Student Activities Office On/Off Campus Activities Approval Form Name of Organization: ___________________________________________________________ Activity: _____________________________________ Date: _______ Time: ______-______ Purpose of Activity: ______________________________________________________________________________ ______________________________________________________________________________ Location: ____________________ Admission/Cost to Participate_________________________ Is this event open to the University public? Yes No Will this event be published in the local oral/print media? …
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Appendix D UVI Student Activities: Revised Summer 2013 Student Activities Office On/Off Campus Activities Approval Form Name of Organization: ___________________________________________________________ Activity: _____________________________________ Date: _______ Time: ______-______ Purpose of Activity: ______________________________________________________________________________ ______________________________________________________________________________ Location: ____________________ Admission/Cost to Participate_________________________ Is this event open to the University public? Yes No Will this event be published in the local oral/print media? Yes No Special Arrangement/Request: (List all items that you would need from Student Activities.) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________ ______________ ________ ____________ Person in Charge of Activity E-mail Address Mailbox# Telephone No. UNIVERSITY OFFICIAL TO SUPERVISE THE EVENT ____________________________ ________________________ ________ _______________________ ________ President’s Signature Date Advisor’s Signature Date CHECKLIST: (please make sure that these things are in place) Cleaning/Security Deposit Check Requisition(s) to cover expenses Alcohol Permission request List of students participating for Walk-A-Tons Name of Police Officers: ____________________________ _______________________________ Name Phone # Name Phone # DO NOT WRITE BELOW THIS LINE___________________________________________ UVI Security Officer cooler___ cash pan____ table____ Other items__________________________________________________________________ Approved: Yes No Comments: ______________________________________ ______________________________________ ______________________________________ _______________________ ________ ______________________________________ Student Activities Supervisor Date *Please walk with this form and contact security at 693-1530 before to open and after the event to secure the site* cc: Security, Physical Plant, Custodial, ITS, Cafeteria SIGN SIGN