Center for Student Life and Leadership Development
College of San Mateo
Student OrganizaƟon AcƟviƟes Request Form
InstrucƟons This completed form must be submi ed to the Center for Student Life and Leadership Development (CSLLD) at least four (4) weeks
prior to the date of the event. The Student Life and Leadership Manager will review details of the event and gather addi onal informa on as is
necessary. No event is approved un l wri en confirma on is provided by the CSLLD. All ac vi es must be sponsored by a recognized campus
group, organiza on, or office/department.
Sponsoring
Group
AcƟvity
Name
Please provide a brief descripƟon of the event.
Student
Lead
Phone/
Email
Group
Advisor
Phone/
Email
Event
Monitor
Phone/
Email
If different from group’s primary advisor. Must be a college employee.
Facility
Requested
EsƟmated
AƩendance
End
Time
Admission
Fee (if any)
Will food be served?
 Yes
 No
If yes, what?
Will this event include amplified sound?
 Yes
 No
If yes, what?
 Sound System  Microphones
Media Equipment
FaciliƟes
Start
Time
Date(s)
 CD Player
Tables #
Special Services
 Security
 TV
#
 Parking
Podiums #
 VHS Player
 MP3 Connector  Other
 Projec on Screen  Projector
Chairs #
 DVD Player
Stage
Other
 Food Service  Performance Contract Other
Signature of Lead Student Organizer
Date
Signature of Group Advisor
Date
Signature of Event Monitor/Chaperone (if designated)
Date
Signature of CSM Student Life and Leadership Manager
Date
Revised July 2014