F ACILITIES U SE A PPLICATION AND A GREEMENT
Date of Application:
Date(s) and Time of Event:
Name of Applicant Organization: Address:
City/ State/ Zip: Contact person: Address (if different): City/ State/ Zip: Email address:
Phone:
CCAC Space Being Requested: Purpose for Use of CCAC Space (Be Specific):
Estimated Attendance: Will money be transacted?
If Yes, explain:
Will food/ beverage be served?
If Yes, explain:
Do you have special requirements?
(Maintenance, Audio/Visual, Electrical, Parking, Furniture, etc.)
If Yes, Specify:
Everyone requesting Media Services, must complete the “Media Services Equipment Request Form” found on the ITS pages at: http://www.ccac.edu/default.aspx?id=152773. The Application for Facilities Usage, evidence of required insurance and the Facilities Usage Fee Schedule must be submitted to the Facility Coordinator at least (3) three weeks prior to the date of requested use. Your signature on the line below represents your agreement that your use and rental of CCAC’s facilities will be subject to and contingent upon your agreement to the College’s Facilities Use Regulations, which are incorporated by reference. Applicant’s Signature: Date: Printed Name and Title:
Appendix H
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