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: