Activity Request Form or Community Service Form

•Fill out form completely and submit. The form will automatically be sent to Student Success and Support Services Office
•Form must be turned in at least two weeks prior to event

Name of Activity or Event
Is this associated with a fundraising event or activity?
If so, please fill in the appropriate sections of this form and also submit a fundraising form as well.

Is this associated with a fundraising event or activity?
If so, please fill in the appropriate sections of this form and also submit a fundraising form as well. Yes No
Brief Description of Activity or Event
Date of Activity or Event Date of Activity or Event / MM / DD YYYY
Starting time of the event Starting time of the event : HH MM AM/PM
Finishing time for event Finishing time for event : HH MM AM/PM
Organization
Name of Organization President Name of Organization President First Last
Email of President
Phone of President Phone of President - ### - ### ####
Name of Member in Charge of Event (If different from the President) Name of Member in Charge of Event (If different from the President) First Last
Email of Member in Charge
Phone Of member in Charge Phone Of member in Charge - ### - ### ####
Faculty Advisor(s) for Activity or Event

Faculty Advisor(s) for Activity or Event Charles Breese Donna Breese Melissa Burmeister Elina Delgado Timothy Fincher Will Graham Kristin Kellett Nicole Lounsbury Michael Malloy Joseph Nosser Samantha Odem Troy Smith Robin Vidal Kris Virga Abby Weldon Dave Weldon Jenny White Caiyun (Jane) Yang Whitney Zumwalt
Approximate Number of Student / Faculty Attendees
Location of Event
On-Campus Room Preference (room locations are not guaranteed)
Room Layout for Belmont Room (number of tables, chairs per table, etc)
Items Needed for Outdoor Event (tables, chairs, etc)
Items Needed for Off-Campus Events (tables, chairs, etc)
On-Campus Event Items that are Needed
Location of the Off-Campus Event
Identify events that function as:

Identify events that function as: Co-Curricular Activity Community Service Activity
Co-Curricular Domain
Community Service Cause
Will the Activity or Event Require any of the Following:

Will the Activity or Event Require any of the Following: Food Service P-Card Purchase Ice (contact facilities in advance)
Menu and approximate costs (if known) for food service items
Food Vendor
Approximate Cost of Food Service (Costs greater than $300 require prior approval)
Other items to purchase for event and approximate costs
Total Costs (including food service) for this Activity or Event
I understand that my organization and I are in charge of this event and will uphold the policies and beliefs of William Carey University (Please type your name in agreement)