APPLICATION FOR USE OF FACILITIES Hibbing Community College
Organization making request: ______Profit ______Non-profit ______Government Agency ______MinnState______Activity being scheduled: Estimated Attendance: ______Do you charge participants for this activity? Yes No
Date(s) facility is requested for: Event Time: AM/PM to AM/PM Please circle AM or PM Please circle day(s) of week: S M T W R F S Reserved Time: AM/PM to AM/PM
PLEASE CHECK THE SPECIFIC COLLEGE FACILITY YOU WISH TO USE:
Admin Conference Rm (C102) _____ Classroom _____ Computer Lab* (D110 _____ College Center Conference Rm (G109) _____ Classroom _____ Computer Lab* (D130) _____ ITV Room (B209) _____ Classroom _____ Computer Lab* (D132) _____ Summer Only ITV/Teleconference Rm (B212) _____ Classroom Computer Lab* (C222) _____ Summer Only L10 _____ Ceramics Bldg _____ Computer Lab* (C223) _____ Summer Only Nursing Simulation Lab (C239) _____ Commons _____ Computer Lab* (L112) _____ Other _____ Dining Room _____ Theater (Request is done on a separate Theater application form)
*If requesting to use a computer lab, you must complete a ‘Computer Support Services Form’. Computer support services are based upon availability. A three-(3) business day’s notice is required for a computer lab without the use of specialty software. If software is required, Computer Services will need the software 10 working days in advance, prior to the date of the class.
Special Equipment/Needs: Projector / computer / overhead / wireless access / small sound system equipment (Please circle items needed or write in) Other ______ATHLETIC FACILITIES:
PE104 (for meetings or concessions) Baseball Field Gymnasium (without seats & time clock) Softball Field Gymnasium (with seats & time clock) Football Field Multi-Purpose Room/Gym Special Needs (bleachers, volleyball nets, batting cages, etc.):
Insurance (HCC will inform you if this is required)
Minnesota State system policy requires a Certificate of Insurance that includes $2,000,000 general liability minimum and Minnesota State DBA: Hibbing Community College listed as a named additional insured. If you have questions about this, please contact Karen Kedrowski, [email protected]. Yes, my organization has the required liability insurance and will provide a copy along with this agreement. Please read policy and sign on other side An Equal Opportunity Educator & Employer
Facility Use Form & Forms dsk rev. 4/1/13, 11/16/15, 4/18/17 PLEASE READ THIS POLICY AND SIGN BELOW. THANK YOU.
1. It shall be the policy of the College to make its facilities available, as a community service to civic non-profit organizations, provided that such usage does not conflict with college functions. 2. Organizations using College facilities will be held responsible for any damages to property. 3. College activities shall have priority over calendar reservations for use of all College facilities. 4. The reservation calendars are maintained by the contact person(s) on each campus. 5. The College facilities are ALCOHOL, TOBACCO and DRUG FREE. 6. The College reserves the right to be represented at any of the functions involving usage of facilities. 7. Maintenance charges will apply to any group when a custodian is not regularly scheduled (at a minimum of 2 hours). 8. Audiovisual equipment use is based upon availability. A three-(3) business day’s notice is required. 9. The use of specialized equipment, such as stage lighting and sound, requires the provision of qualified and approved personnel. 10. Computer support services are based upon availability. A three-(3) business day’s notice is required for a computer lab without the use of specialty software. If software is required, Computer Services will need the software 10 working days in advance, prior to the date of the class. 11. Tennis shoes with clean soles are required on all gymnasium floors. 12. NO CHILDREN ALLOWED during adult recreation leagues. 13. It will be the responsibility of the user to return area and/or equipment used back to its original state. Failure to do so, (i.e. damaged or lost equipment, classroom in disarray, unclean kitchen) will result in additional charges to user as College sees fit.
Person making request: Date: PRINT \ SIGNATURE
Address: Telephone: ______Email address: ______After completing and signing this form, please return to Carrie Pearson [email protected] or Cynthia Pogorels [email protected] for processing. If you have questions regarding this application, please contact: Carrie Pearson, 218-262-7259 or Cynthia Pogorels, 218-262-6707
MAINTENANCE CONTACT NUMBERS: 218-969-3019 OR 218-969-6019
DO NOT WRITE BELOW THIS LINE - FOR COLLEGE USE ONLY
Approved Not Approved Signature:
Estimated Charges: Date: Facilities: Copies to: Business Office Computer Services
Maintenance: Library Maintenance
Other Other ______
Comments: ______
______
An Equal Opportunity Educator & Employer
Facility Use Form & Forms dsk rev. 4/1/13, 11/16/15, 4/18/17