Student Organizations - Application for Use of Student Services Building Meeting Rooms

For reserving rooms through 8/21/2012.

Name of Organization:

Proposed activity (be specific):

Number of people expected:

Room Choices - Please list choices in order of preference (more than one room number per field may be entered). Only one room will be assigned unless multiple rooms are requested in the comments field. Other rooms may be substituted if the preferred rooms are uavailable.

Room choice 1: Room choice 2: Room choice 3:

Are you requesting (choose one option only):
weekly semester-long reservations (e.g., every Wednesday from 8/31/05 through 12/7/05)
All other reservations/individual dates
(Don't include Thanksgiving or Spring Break unless you are really going to meet then.)

Proposed days of reservation:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Proposed dates of reservation (mm/dd/yyyy):
From: Through:

Proposed dates of reservation (mm/dd/yyyy):
On Date: On Date:
On Date: On Date:
On Date: On Date:
On Date: On Date:
On Date:

Reservation Times:
From: : Until: :

OFF CAMPUS SPEAKER:
Do you plan to present an off campus speaker?
Yes No

Name of the Speaker(s):
Will the speaker entertain questions from the audience?
Yes No

NOTE: The speaker must be the invited guest of a registered student organization. Complete a reservation request at least 48 hours in advance. The speaker may not distribute literature that discusses/promotes a product or service. The speaker may not discuss/promote a product or service that is for sale. The speaker may not sell or offer to sell any product or service.

LITERATURE AND SIGNS:
Do you plan to post signs on kiosks around campus?
Yes No
If yes, be sure your organization complies with guidlines outlined in "Information Sheet for Posting Signs"

Do you plan to distribute petitions, handbills, or literature?
Yes No

Be sure your organization complies with guidelines outlined in Institutional Rules

SPONSORSHIP AND SOLICITATION:
Is this activity solely sponsored by the organization/applicant?
Yes No

List co-sponsoring organizations(s):

Do you plan to collect any money?
Yes No

Please indicate your Student Organization Bank Account Number:

Briefly describe type of solicitation:

Do you plan the distribution of food and/or drink?
Yes No

Please describe the food to be sold or distributed. (Be specific.):

A valid permit signed by the Office of Environmental Health & Safety (EHS) must be present at the event where potentially hazardous food is being served. Potentially hazardous food is food that, if handled or prepared improperly can cause a food borne illness. DO NOT submit forms for food that is not potentially hazardous, such as candy, soda, chips, or bake sale items (e.g., cake, cookies, brownies). Disciplinary action can result for organizations that do not comply with food policies.

The following guidelines also apply when registered student organizations serve food:

The area or room must be cleaned after use. All trash must be picked up. If necessary, the tabletops and floor must be wiped down and dried.

The organization must provide their own trash bags and all trash must be taken to a dumpster outside of the building.

Failure to comply with any of the regulations related to serving food on campus may result in disciplinary action, including the potential loss of the ability to use university facilities.

Food permits are available at: http://www.utexas.edu/safety/ehs/forms/index.html or the Service Building, Room 202.

Comments:

Name of Authorized Representative:
(Must be an authorized representative in order to apply.)

Phone Number:

Email:

You will receive a confirmation from our office when this form is processed.