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Student Life & Leadership 3900 University Blvd UC 3400 Tyler, TX 75799 903-565-5645 getconnected@uttyler.

edu
OFFICE USE ONLY
Date Received: Initials:
EVENT/FACILITY REQUEST FORM
REQUESTS MUST BE SUBMITTED to getconnected@uttyler.edu or UC 3400 AT LEAST 7 DAYS PRIOR TO THE EVENT.

Organization/Department Name:

Event Title:

Event Date (list additional dates below):



Event Start Time: Event End Time: Set-Up Begins At: Take Down Ends At:
Is this request for an Information Table only? Yes No
Location (in order of preference):
Room Style: Expected Attendance:

Description of Event:



Co-sponsor(s) of event: ________________________________ Primary Audience: ______________________

Will you have a Guest Speaker?: Yes* No If yes, who? _________________________________________________

Will you be collecting any money? Yes* No Will you charge admission? Yes* No

Will you collect donations? Yes* No
*If you are collecting money for anything other than membership dues, submit a Fundraiser/Solicitation Approval Form with this Facility
Request Form.
Will you be distributing food? Yes* No If yes, describe:
*A Food Approval Form must be submitted with this Facility request form if food from an off-campus restaurant or caterer is being served.
Will you be using amplified sound at an outdoor location? Yes* No
*If yes, provide a description of the amplified sound below (must be approved through Student Life and Leadership):







FORM CONTINUED ON NEXT PAGE



OFFICE USE ONLY Registered Student Organization Department Confirmed By: Date: ____
Event Approval by Director of Student Life and Leadership: Date: ____
Request #: AV: Set-up: ____



Student Life & Leadership 3900 University Blvd UC 3400 Tyler, TX 75799 903-565-5645 getconnected@uttyler.edu
AFTER your request for space is CONFIRMED by the Office of Student Life & Leadership:


**To request/reserve the use of AUDIO/VISUAL EQUIPMENT, including microphones, speakers, overhead
projectors, projector screens, sound system, etc. for your event, contact:

Educational Technology via their online request form at http://www.uttyler.edu/ets/service.php
Eric Engler at eric_engler@uttyler.edu or 903-566-7014 if your event will be held in the University Center



**Your organization is responsible for paying replacement costs if equipment is damaged or missing. Educational Technology Services
reserves the right to determine when to stop delivery, set-up, operation, and retrieval of equipment.

**To request FURNITURE for your events or to arrange any SET-UP NEEDS, contact:

Service Solutions at lburks@uttyler.edu or 903-566-7290
*Eric Engler at eric_engler@uttyler.edu or 903-566-7014 if your event will be held in the University Center

*University Center Furniture needed:
Round Tables (seat 7) ' Tao|es
Podium 3lag|rg (1' x 8' eacr) _____________ Easels

**In the box below, provide a description of how you will be using the A/V equipment and/or furniture:



Authorized Representative:
Phone: E-mail:
Alternate Contact:
Phone: E-mail:
Advisor: E-mail:
By submitting and/or signing this form, you verify that your organization is solely responsible for fees assessed due to damage,
inappropriate room usage, or cleaning fees and room rental outside of regular operating hours. You also agree to follow the rules and
regulations set by The University of Texas at Tyler in the Manual of Policies and Procedures, the Student Organization Handbook,
building and department hd^ZZ
When submitting electronically, ADVISORS MUST BE COPIED TO THE E-MAIL and the e-mail
must be sent from the PATRIOTS ACCOUNT of the authorized representative listed above.

Authorized Representative Signature (for hard copies) Date Advisor Signature (for hard copies) Date
* SUBMIT THIS FORM TO GETCONNECTED@UTTYLER.EDU OR UC 3400.


SL&L will forward all DEPARTMENT FACILITY REQUESTS to the individual responsible for reserving the requested space.