Dance/Party Planning Form
Middle Tennessee State University
Division of Student Affairs
Name of Organization: __________________________________________________________________
Primary Event Coordinator: ______________________________________________________________
Name, email, and phone number
Secondary Event Coordinator (s): __________________________________________________________
Name, email, and phone number
Title of Event/Activity: __________________________________________________________________
Date (s) of Event: ___________________________ Location: __________________________________
Start Time: _____________ End Time: _____________
Estimated attendance: _________________
Other Organizations/Departments Involved: _________________________________________________
If indoors, the structure in which the activity is to be conducted has been approved by the Fire Marshall
for a maximum occupancy of _______ people.
Will there be alcohol at this function (only if the event occurs off campus)? YES or NO
If yes, you must fill out the Statement of Assurance Concerning the Responsible Use of Alcohol Form and
turn it in with this form.
Have you properly reserved the location? YES or NO
Have you met with the representatives of the hired security agency (if on campus)?
YES or NO
Who is the primary contact with the security agency (please give his/her phone number)?
Briefly describe the event/activity:
What are some possible risk management issues associated with this event/activity?
What measures have been taken to reduce these associated risks?
List the members of the organization that will be assisting security (i.e. ARISTO, etc.) and outline
their areas of responsibility:
How are you going to advertise your event/activity?
Describe where vehicles will park and what procedures will be used to ensure University Parking
rules and regulations are followed (if on-campus)?
Are you contracting any services from a non-university entity or agency?
YES or NO
Be sure contracts are established and entered into according to University policy.
I attest the above information is correct. I understand that alcohol is not allowed on University
property, including the fraternity houses on Greek Row. This includes alcohol in any type of
container (can, bottle,cup, etc.)
•
If the following signatures are forged, your organization automatically waives its privilege to
host additional functions for one full semester from the date of this function and will also be
subject to the disciplinary action by the Office of Judicial Affairs and Mediation Services.
This form was completed by _______________________________________on ___________________.
Name and Title
Date
___________________________________
Organization Social Chair (Print)
____________________________________
Organization Social Chair (Signature)
___________________________________
Organization President (Print)
____________________________________
Organization President (Signature)
___________________________________
Organization Advisor (Print)
____________________________________
Organization Advisor (Signature)
FOR OFFICE USE ONLY:
Date Received:__________________________ Received by: _____________________________
Approved
Not Approved
Approved with the following modifications:
_________________________________________
Signature of Approving Authority (MTSU)
_____________________
Date
_________________________________________
Signature of Approving Authority (Security)
_____________________
Date