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

Organization
Name of Activity or Event
Is this event associated with a general membership meeting?

Is this event associated with a general membership meeting? Yes No
Is this event associated with a Community Service Activity:

Is this event associated with a Community Service Activity: Yes No
Brief Description of Activity or Event and expected number of participants.
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
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
Name of Organization President Name of Organization President First Last
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 President or 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 Samuel Bobo Charles Breese Donna Breese Melissa Burmeister Timothy Fincher Will Graham Mary Long Kwadwo Mfoafo Joseph Nosser Samantha Odem Ron Reed Nicole Rivera Troy Smith Robin Vidal Kris Virga Abby Weldon Dave Weldon Jenny White Caiyun (Jane) Yang Whitney Zumwalt
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 any On Campus Event (Ice, trash cans, tables, chairs, Technology Microphone/Projection, Guest WIFI Access, Campus Security (including admission to campus for non-students or faculty), etc)
Location of the Off-Campus Event
Items Needed for Off-Campus Events (tables, chairs, etc)
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
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)