Middlebury College
Application for Student Fundraising / Concession Permit
Please Circle One:
Fundraising
Concession
Applicant’s Name: ___________________________________
Box #: ______
Extension #:: ______
Date of Application:
____________________
Class: ________
ID#:____________
Dorm: __________________________
Commons : ______________
Student Organization / Group: _____________________________________________
Fundraising:
Describe the activity or project. Include as much detail as possible include project dates, times, projected costs, name of
charity, theme, times, etc. Use additional pages if necessary.
______________________________________________________________________________________
______________________________________________________________________________________
Concessions:
Description of product or details of service(s) provided. Please use additional pages if necessary.
______________________________________________________________________________________
______________________________________________________________________________________
Name of company distributing product (if applicable): _______________________________________
If an item has printing on it (e.g. artwork or working on a T-shirt) describe content and intended text:
______________________________________________________________________________________
______________________________________________________________________________________
Describe your advertising plan: ___________________________________________________________
______________________________________________________________________________________
Price or fee to be charged: ________________________
In understand that all advertising materials (posters, flyers, etc) must be cleared through the Center for Campus Activities
and Leadership before distribution. I understand that my Permit Number must be included on all advertising. I also
confirm that in signing this form I acknowledge that I have read and understand the regulations for Fundraising and
Concessions and agree to abide by them.
Applicant’s signature:
___________________________
Date:
__________________
Director of Dining Services signature (required for fundraising or concessions involving the sale or distribution of food):
_________________________________________________
Date:
__________________
Center for Campus Activities and Leadership representative’s signature (required):
_________________________________________________
Date:
__________________
Permit #:
__________