Philanthropy Registration Form
Chapter Name:_________________________________________________________________________
Coordinator(s):_________________________________________________________________________
Email(s):______________________________________________________________________________
Phone Number(s):______________________________________________________________________
Title of Event/Activity:___________________________________________________________________
Benefitting Organization: ________________________________________________________________
Location: _____________________________________________________________________________
*Make sure you reserve the appropriate facilities for your event-- If on campus, through Guest
and Event Services at 135 IMU and complete an Event Information Form (EIF)
Co-Sponsoring Chapter or organization (if applicable): ________________________________________
Name of contact: ______________________________________________________________________
Phone number: ________________________________________________________________________
Estimate of Number of People Attending: ___________________________________________________
Requested Dates of Event:
1st Preference: ________________________________________________________________________
Start Time: _____
End Time: _____
2nd Preference: ________________________________________________________________________
Start Time: _____
End Time: _____
3rd Preference: ________________________________________________________________________
Start Time: _____
End Time: _____
Event Description (If your event includes more than 1 activity, please describe them ALL):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
A representative from the benefiting organization WILL BE contacted for approval.
Name: _________________________________________________________________________
Address: _______________________________________________________________________
______________________________________________________________________________
Phone Number: _________________________________________________________________
Email Address: __________________________________________________________________
A representative from the national fraternity/sorority that is sponsoring the event WILL BE contacted for
approval.
Name: _________________________________________________________________________
Address: _______________________________________________________________________
______________________________________________________________________________
Phone Number: _________________________________________________________________
Email Address: __________________________________________________________________
1. Are you using an assumption of risk/waiver, medical release, and emergency contact form?
Yes
No
*If you need to create a waiver, please contact Associate Dean Tom Baker at Thomasbaker@uiowa.edu
2. Does your event involve physical activity? Yes
No
*Plan ahead for medical emergencies. To secure EMS Personnel, contact Iowa City EMS/ Fire
Dept. at 319-846-3178.
3. Is your event held outside the Iowa City/Coralville area? Yes
No
*Review the University of Iowa policy concerning student travel. See IMU 159, the Fraternity
Business Services.
4. If you are traveling, what type of transportation are you using?
Personal Vehicle
University Vehicle
Rental Car
University/Chartered Bus
Other ___________________
5. Will your event require the assistance of the University Police for security and/or Parking, Traffic,
and Transportation Services for parking and traffic control? Yes
No
*For assistance contact the University Police Department at 319-335-5022 or UI Parking Services
at 319-335-1475
6. Is your event open to (check all that apply)?

Fraternity/Sorority members only

University of Iowa students





University of Iowa faculty/staff





General Public




7. Are you contracting a service from a non-university entity (i.e. Aero Rental, Tow Truck company, ?
Yes
No
Agency’s name: __________________________________________________________
Services being contracted: _________________________________________________
8. Does your event involve the sale/distribution of items on campus? Yes
No
*See Policies & Regulations affecting Students for more information.
9. Are you planning on posting flyers or advertising on campus? Yes
No
*To obtain a copy of the Policies and Regulations affecting students, see University of Iowa
website at www.uiowa.edu.
10. Are you using a University of Iowa logo or trademark in association with your activity (i.e. t-shirts,
posters, or other marketing materials)? Yes
No
*See Fraternity Business Services and then Crysta Roberts or Dale Arens in the University
Licensing and Trademark Office. *Provide all major logos/trademarks on separate sheet*
11. Have you reviewed your budget and purchasing guidelines as it relates to this event? Yes
No
*See Char Sojka in Fraternity Business Services 319-335-3072.
_______________________________________
(Signature of Event Coordinator)
Received by:
_______________________
Office Use Only
(initials)
_______________________________________
(VP of Philanthropy & Community Service IFC/PHC)
_______________________________________
(Signature of Greek Advisor)
_______________
(date)
_______________
(date)
_______________
(date)
_______________
(date)
**Please keep a copy for your chapter’s records**
**Chapters that attend all Philanthropy and Community Service Roundtables will receive first priority over
philanthropy dates.
**Chapters that followed all Philanthropy and Community Service Guidelines in the preceding semester will
receive first priority over philanthropy dates.
**VP’s of Philanthropy and Community Service will make every effort to give each chapter a date that is
convenient for the chapter; however, in the case of two chapters requesting the same date where all other factors
are equal (see previous statements) the chapter that submits a correctly completed Philanthropy Registration
Form first will have preference over the disputed date.
**Please return this form to the Office of Student Life (145 IMU) by 4:00pm on April 15th **
If you have any questions or concerns, please contact Rachel-kentor@uiowa.edu or william-fdavies@uiowa.edu .
Example Invoice

If you are billing chapters for attending your event, you can use this form or
something similar
Date: ______________________________________
Due Date: __________________________________
Chapter Event: ______________________________
Bill to:
Chapter: ___________________________________
Qty
Description
Cost
Total
Grand total:
Attention: Treasurer
Upon completion of these forms submit to appropriate chapter mailboxes in the Fraternity Business
Services (room 139)
Philanthropy Evaluation Form
This must be completed and returned to the VPs of Philanthropy & Community Service by a month after
your event. Let us know if you are going to be late with this.
In this evaluation please include the following:
1. A detailed description of the event including:
A. Aspects of event that were successful
B. Any problems that occurred
C. Suggestions for further improvement
D. Chapters that participated
2. A letter from your charity or a copy of the check written confirming the receipt of your payment
(proof of donation).
This evaluation is meant to be a resource for your chapter, as well as a follow up and basis for further
improvement. Please keep a copy for your records.