<p> SPECIAL EVENT REQUEST FORM FOR ESF STUDENT ORGANIZATIONS</p><p>1. Sponsoring ESF Student Organization: ______</p><p>2. Application Submission Date: ______</p><p>3. Contact Person: ______Name ______</p><p>Position</p><p>______</p><p>SYR Email Address</p><p>______</p><p>Cell Phone Number </p><p>4. Description of Event: ______</p><p>Date: ______Time: From ______am/pm until ______am/pm</p><p>Location: ______Estimated Attendance: ______</p><p>Rain location (if applicable): ______</p><p>5. *Event is open to whom: </p><p> a.____Students</p><p> b.____ESF Employees (Faculty, Staff, Administration)</p><p> c.____Open to the Public</p><p> d.____Other Specific Groups. Clarify:______* If your event involves youth (under the age of 18), please review Mandatory Reporting and Prevention of Child Sexual Abuse.</p><p>6. Financial Arrangements: (Please check appropriate box and explain)</p><p> a.____Event is free to participants.</p><p> b.____Event has an associated admission charge. </p><p>Explanation of event funding: ______</p><p>______</p><p>7. Event History: (Please check appropriate box and explain)</p><p> a.____Event is an annual event and will be the same as previous years.</p><p> b.____Event has been done before but has significant changes.</p><p> c. ____Event is a brand new event altogether. </p><p>Explanation of event: ______</p><p>______</p><p>8. If the event is a student club/organization sponsored event, the name and contact information of the faculty/staff advisor or faculty/staff member who endorses the event and who commits to being in attendance for the entirety of the event:</p><p>______</p><p>Name Phone Number and ESF/SYR Email Address</p><p>9.  Check box when complete. Additional Information (typed on a separate sheet of paper): a. What is the purpose, intended outcome, and rationale for this event? 2 b. Is this a new event of its kind? Could you provide concrete documentation that shows this event, activity, or program has no safety and liability concerns?</p><p> c. Will food be served? Y/N ___ If Yes, will food be prepared on site and provided by a licensed caterer?</p><p> d. Will there be alcohol at this event? Y/N ____ (Please fill out the Application for Permission to Serve, Use, and Distribute Alcoholic Beverages if Yes)</p><p> e. Are there any transportation/parking needs associated with this event?</p><p> f. Are there any contracts? Has payment been processed?</p><p>10.  Check box when complete. Please include an exact diagram of the space and your event including the rain location diagram plan. </p><p>I have read the “Student Code of Conduct” and understand the department/organization/entity responsibilities and liabilities in regard to ESF’s policies and in regard to federal, state, and local laws, rules, regulations, and statutes. I affirm that all information reported on this form is complete and accurate.</p><p>Person Responsible (See Above):</p><p>______</p><p>Name (Printed) Department/Student Organization Position</p><p>______</p><p>Signature Phone ESF/SYR Email Address</p><p>______</p><p>Name (Printed) Name of Student Organization President/Treasurer</p><p>______</p><p>Signature Phone ESF/SYR Email Address</p><p>Please submit the completed form and appropriate attachments to the Division of Student Affairs for review prior to receiving the appropriate signatures below.</p><p>A. For events to be hosted by ESF-sanctioned student clubs and organizations, a review by the Dean for Student Affairs (or designee) is required before seeking approval from the Vice President for Administration (or designee). This would also include a thorough review by the Student Association liability insurance representative to ensure adequate coverage would be available for the event.</p><p>______3 Name (Printed) Signature and Date Title</p><p>B. Approval of Physical Plant:</p><p>______</p><p>Name (Printed) Signature and Date Title</p><p>Additional Requirements: ______</p><p>C. Approval of University Police:</p><p>______</p><p>Name (Printed) Signature and Date Title</p><p>Additional Requirements: ______</p><p>D. Approval of Environmental Health and Safety Officer:</p><p>______</p><p>Name (Printed) Signature and Date Title</p><p>Additional Requirements: ______</p><p>E. Review by the Vice President for Administration (or designee):</p><p>An initial review will take place when this completed form is submitted. Tentative approval will be granted (or not) by the Vice President for Administration (or designee), and if approved, additional planning by the event sponsor(s) may take place. Advertising for the event should not be undertaken until tentative approval from the Vice President is received.</p><p> TENTATIVE APPROVAL: ______</p><p> NOT APPROVED: ______</p><p>EXPLANATION: ______</p><p>______</p><p>4 DATE: ______</p><p>The Vice President for Administration (or designee) will provide final approval (or not) for the event and will communicate this approval to the appropriate offices on campus.</p><p> FINAL APPROVAL: ______</p><p> NOT APPROVED: ______</p><p>DATE: ______</p><p>5</p>