Campus Dean
Facility Use Request
□ BHC
□ LHC
□ NCK
□ NMC
Event Date:
Event Name:
Organization/Department:
Hours Needed:
Event Start/End Times:
Estimated Attendance:
Facility Requested:
Point of Contact:
Facility Assigned:
Phone:
Email:
***While MCC tries to provide the equipment listed free of charge, there occasionally may be a small fee
assessed to reserve demand items and/or provide service outside of normal business hours.***
Available Equipment/Request for Equipment:
□ Computer □ Projector □ TV Monitor □ DVD/VCR □ Microphone
□ Whiteboard □ Wall Screen □ Network Drive □ Overhead Projector
□ Podium
□ Stage
□ Other (describe)
***If a specific room set-up is needed, please attach a separate page with instructions and/or drawings***
Event Description (food and/or beverages, etc.):
Will minors be participating or involved in this event? If so, in what capacity?
Fee Schedule:
Date of Application:
Requestors Signature:
Campus Dean Signature:
MCC Form ADM 0006 (rev 09/13/13)
Reviewed By:
Initials: