(FERF)
Facility and Equipment Request Form
*Submit completed form(s) to Facilities Reservations – Zip 720 or Fax: 530-898-4359*
***Please Note: FMS requires 10 working days advance notice for equipment and services.***
Is this an ORIGINAL Request
or an UPDATE
Today’s Date:
?
PART I – EVENT INFO - Must be filled out by Requestor
Event Name:
Event Date(s):
Facility Requested:
Event Time:
to:
(Facility Needed:
to:
)
Brief description of event and envisioned result:
Will any outside vendors/groups participate?
Public invited?
Yes
No
No Admission Fee?
Yes – Vendor/Group Name
Yes
No Fundraiser?
Yes
No
Expected Attendance:
On Campus Requestor: (please complete info)
Requestor:
Dept/Group:
Ext:
E-mail:
Responsible Party at Event:
Student Group or Off Campus Requestor: (please complete info)
Requestor:
Zip:
Cell #:
- Address:
Organization:
E-mail:
- Phone:
Responsible Party at Event:
Cell #:
What is the funding source for this event? (Completion required to process request)
State Funded (General Fund)
Chartfield:
State Self Support /Auxiliary Funded (Univ Affiliated)
Project
Object
Community/Civic Non-Profit
(Non Affiliated)
Private/Commercial
(Non Affiliated)
PART II – EQUIPMENT/SERVICES REQUEST - To be completed if special equipment /services are requested. Please attach instructions/diagrams
if applicable. Additional forms may be required. **Forms available at the Facilities Reservations website: http://www.csuchico.edu/upe/facres
MOVER/CUSTODIAL SERVICES (Facilities Management Services - FMS)
Equipment – Indicate quantities below:
6’ Tables (on-campus only) - Qty:
Folding Chairs - Qty:
Trash Cans - Qty:
Extra Liners – Qty:
Podium
Equipment Drop Off/Pick-up by FMS (7:00 am – 3:00 pm ONLY)
Drop Off: Date
Pick Up: Date
Time
Time
ELECTRICAL SERVICES (FMS)
Pre-event meeting with the FMS Trades Manager REQUIRED for any
need of electrical assistance at event. Call 898-6222 to set up a meeting.
*Enter name/phone of person that has knowledge of electrical needs:
Name:
*Phone:
25’ Cord – Qty:
50’ Cord – Qty:
*Cords to be picked up by requestor at FMS Central Supply.
GYM Bleachers:
Request Set-up/Teardown by FMS.
* Prior approval required - charges will apply.
Restroom Servicing (other than regular campus schedule)
RECYCLING SERVICE (Free service provided by AS Recycling)
HEATING AND COOLING (FMS)
In
Out
STADIUM (FMS)
Lights
Date(s)
Time(s)
*Additional lighting may be required and billed if needed for safety
Unlock Stadium Restrooms
- Indicate dates and times that heating/cooling is needed:
Date
Time
Date
Time
GROUNDS SERVICES (FMS)
Sprinklers Off
Trash Pick-up
MISC SERVICES (Please complete additional form if noted.)
Food - Prep/Cook (Complete-Application for Food Serving Permit**)
BBQ Safety Equipment (Sign out at Facilities Reservations – SSC 120)
Campus Tent (Complete-Campus Tent Request Form**)
Public Address (PA) System – Self-Supported – No Cost
(3 Pieces: Main Speaker Unit, Speaker Extensions & Microphone/stand
Includes RCA Cable, Mini-Jack Cable, XLR Cable & Carrying Cases Reservation Link: http://www.csuchico.edu/tlp/services/equipment.shtml)
PA System – Staff Supported – Delivered & Set-up - $64/CAF
(Add’l charges if Tech is needed at the event to operate equipment.
Complete-AV Technology/Theatre Use Planning Form**)
Other Media (microphone, speakers, projector, DVD/CD player, etc.)
(Complete-AV Technology/Theatre Use Planning Form**)
Theatre Use – PAC Theatres and LAXS
(Complete-AV Technology/Theatre Use Planning Form**)
OTHER
***OFFICE USE ONLY***
PART III
Form of payment:
IC #
SAO #
CAF #
Signature/Date:
Service Center Approvals (if required)
Student Activities
Name:
Associated Students
Date:
Facilities Reservations (Facility Confirmation)
Distribution: [ ] Event Calendar
[ ] FMS
[ ] AO
Last Updated 11/10/10