Union County College
Application for Use of Facilities
(Must be submitted no less than 21 days prior to the event date)*
Name of Applicant__________________________________________
Department or Name of Organization ___________________________
Address ____________________________________________________
Phone No._________________ E-mail address_______________
The applicant/organization is (choose one) Part of UCC o
Non-Profit o
For Profit o
Name of Person Responsible for Event (if different than applicant)
_____________________________________Phone #________ e-mail__________
EVENT DETAILS
Date of Event _____________
Time: Start_____ Finish______ Time of Arrival for Set-Up ____________
Total Anticipated Attendance ______ [Adults ____] [Children (17 and under)_____]
Does your audience require special accommodation due to disability ? o yes o no
If yes, how many individuals require Americans with Disabilities(ADA) accommodation? (e.g. wheelchair access, deaf or blinding interpreting) _____
Will there be a tickets be sold or a fee charged for attendance? o yes o no
If yes, how much is the entry/ticket fee $______
Does Event involve raffles or games of chance?* o yes o no
Will cash or other funds be collected during the event? o yes o no
EVENT LOCATION
Cranford
oRoy Smith Theater
oThe Commons (entire)
oThe Commons (lower level) only)
oThe Commons (upper level only)
oSeminar A
oSeminar B
oSeminar A & B combined
oExecutive Education Center
oPresident’s Conference Room
oAdministrative Conference Room
oAlumni Conference Room Classroom (specify)
______________________
oLecture Hall (specify)
______________________
oCafeteria
oGymnasium
oFaculty/Staff Dining Room
oOther (specify)
______________________
Elizabeth
o Theater
o Cafeteria
o Conference Room
o Classroom (specify) ________
o Lecture Hall (specify) _______
o Other
Plainfield
o Conference Room
o Lecture Hall (specify) _______
o Cafeteria
o Classroom (specify) ________
o Annex Room 127
o Other (specify)
FURNITURE/EQUIPMENT REQUIREMENTS
Furniture Arrangement: For options use attached diagrams.
Conference Equipment Requirements:
o Flip Chart/Markers
o Blackboard
o Easel
o Podium
o Extra table (e.g. registration)
o Other (specify) ___________
Audio Visual/Media Requirements: (if multiples requested please note number next to item)
_#_
oSound System _____
o Microphone & stand _____
oWireless Microphone& stands _____
oLapel Microphone _____
o35 mm Slide Projector _____
o Movie Screen _____
oStandard Overhead Projector _____
oComputer Projection System _____
oVCR Monitor (VHS) _____
_#_
oVCR/Video Projector _____
oSatellite Downlink _____
oVideo Camcorder (VHS) _____
oDVD Player _____
oClassroom Casette Recorder _____
oBetacam SP Videocasette Player _____
oPhone Line _____
oOther (specify) ___________________
FOOD & BEVERAGE REQUIREMENTS
(Note: All food must be obtained through Corporate Chefs (908 709-7688 and those arrangements are the responsibility of the applicant. NO food or beverages may be brought from the outside without the express prior permission of Union County College.)
Will food be served? o yes o no Will food be sold? o yes o no
Will your attendees seek to dine in the college cafeteria on a cash basis during regular cafeteria hours? o yes o no
Does the Event anticipate serving alcoholic beverages?* o yes o no
IMPORTANT NOTICE: At least 7 days prior to the event, applicants who are not part of the College will be required to provide the College a certificate verifying the maintenance of comprehensive liability insurance in the amount of $1 million per occurrence and $2 million aggregate and naming Union County College as an additional insured under the user’s policy for the day(s) of the event. Failure to provide this insurance will result in event cancellation.
____________________ _____________________
Signature of Applicant Title
Date Received _______________
Date of Request ______________
By__________________________