Facilities Request Form

Please mark the desired location in Wheelock Student Center or Trimble Hall:

Please print, fill out form and mail or fax it to: Kristi Maplethorpe (see address and fax number at right)

ApplicationDate: ___/___/___

Event Date: ___/___/___

Event: ________________________________________

Purpose of Event: ______________________________

Sponsor: ______________________________________
(Organization/Department)

___ Registered Student Group

___ University Department

___ Other: ________________________________

Cosponsor:

___ Registered Student Group

___ University Department

___ Other: _________________________________

Billing Information: ___________________________

_____________________________________

Will food be served? ___ Yes ___ No

If so, will UPS Food Service be catering?
___ Yes ___ No ___ Buffet ___ Full Service

Will an admission be charged? ___ Yes ___ No

Will alcohol be served? ___ Yes ___ No

Responsible Person: ___________________________

Address: __________________________________

Telephone: ________________________________

Requested by: _________________________________

Address: __________________________________

Telephone: ________________________________

Please mark if needed:

AV Equipment:
___ Screen
___ Projector
___ Overhead
___ Extension cord

TV/VCR
___ Microphone(s)
___ Stage/Risers (Size: ____________)
___ Dance Floor

Setup:
___ Standard
___ Special
___ Theater style
___ Lecture

Please draw a picture of how you want the setup done.
(North is at top of page)

___________________________________________
Signature

Scheduling Office
University of Puget Sound
1500 N. Warner St.
CMB 1069
Tacoma, WA
98416-1069

253.879.3236
253.879.3810 (fax)
E-mail

Trimble Hall Policies
& Procedures

Wheelock Student Center Policies & Procedures

WSC Meeting Rooms

Dining & Conference Services

Facilities Services