Facilities Request Form - Southern Arkansas University
Request to reserve campus facilities must be submitted via e-mail attachment to the Office of Vice President for Academic Affairs (kdcrisp@saumag.edu) or for Reynolds Center (klcarrothers@saumag.edu) a minimum of ten (10) working days prior to the date of intended use.
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Facilities Request Form
|Date sent: |Please check appropriate box(es) event for: |
| |University Calendar News Release |
|Date Received: |Food Service University Police |
| |Heating and Cooling Unlock building/room(s) |
Request Information
|Event: |
|Day(s) of the week and date(s) room(s) needed: |Event start time Event end time |
| | |
|Building and rooms requested: |Reserved/set up time Reserved/take down time |
| | |
|Estimated Attendance: |Police required: | Yes No Number of officers: |
| | | |
Sponsor Information
| Student Group |Organization: Sponsor's Name: |
|Faculty/Staff group |Phone Number (with area code): |
|External Group |Mailing address: |
| |Slot #: (if on campus request) |
|Responsible person (If different than sponsor): |
|Daytime phone number: Evening phone number: |
|The responsible party is responsible for control of the assigned facilities during the period reserved. |
|Required Signature of Sponsor: Date: |
Room Set Up Requests
| |
|Number of Chairs: Number of tables: Number of trashcans: |
|Equipment requested (example - Media, Dollhouse): |
|Special setup requested: (Diagram must be attached) |
|Technicians required for lighting, etc. (Harton): Yes No Number of technicians needed: |
| |
|Sponsor or responsible party must be available and sign for delivered/returned equipment at time agreed upon with Physical Plant. Sponsor or requesting party will |
|be responsible for all equipment delivered. Any items missing or broken will be replaced at the cost of the user group. |
| |
|Usage Fees |
|(to be completed by the building scheduler and the facilities coordinator) |
| |
|Room charge/custodial/utilities $ Fee Required: Yes No |
|Set up charge (tables/chairs, etc.) $ |
|Media equipment charge $ Payment to reserve room is required by: |
|Technicians fees $ Date fee paid: Amount: $ |
|Police Officers $ Receipt Number: |
|Other fees - describe $ |
|Total Charges $ |
SAU Approval – OFFICE USE ONLY
Building schedulers signature: Approval: Yes No Date:
Facilities coordinator signature: Approval: Yes No Date:
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