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The CBC Facilities Request Form:

In order to reserve space in the Center for Black Culture, an authorized representative of a registered student organization or University department should complete this form. The following policies apply to all reservations:

» Center for Black Culture Policies and Procedures (click to display).

Symbol Key:  required Required Information,  error Error
Contact Information:
Your Name: required
Campus Phone: required   (555-123-4567)
E-mail: required
Event Information:
Name of Program or Meeting:  
Sponsor Organization: required
Event Contact Person: required
Contact Phone: required   (555-123-4567)
Contact Address: required
Date of Event: required   (MM/DD/YYYY)
Type of Event:    Meeting           Presentation
 Conference    Other
Start Time: required     AM PM
End Time:       AM PM
Estimated Attendance:  
Setup Date:     (MM/DD/YYYY)
Setup Time:       AM PM
Area Requested:   Please check one or more:
 1st floor main lounge
 1st floor kitchen
 1st floor multi-purpose room (rear)
 2nd floor conference room
 3rd floor multi-purpose room
Services Desired:   Chairs--how many?  
Tables--how many?  
 DVD Player / TV
 Cassette Tape / CD Player
 Podium (floor)
Setup / Special Needs: blank
Regulations guiding the use of University facilities and promotion of events are outlined for student groups in "The Student Guide to Policies." Except as noted in the Guide, University space may not be used for the conducting of religious services or activities that involve the use of alcoholic beverages.

This request is not considered valid until you have received a written confirmation via email from a representative of the Center for Black Culture.

Statement of Responsibility:
I certify that I am an authorized representative of the sponsoring organization/department and have familiarized myself with the University policies regarding this program. My organization will be responsible for adhereing to these policies and for any damage to the facility and its contents.