Sponsor Information:

Sponsor:

Dept. Name:

Applicant's Name:

Applicant's Mailing Address:

City, State, Zip:

Phone:

Email:

Requested TTUHSC Premises:

Requesting to use HSC Indoor Space

Requesting to use HSC Outdoor Space

Requesting to use Outdoor Space for Free Speech Activity

(request no later than two (2) business days prior to activity)

Requesting to Distribute Petitions, Handbills or Literature

Requesting to use HSC Commercial Publication Display

Please complete the following questions regarding the area requested for use:

1. Specific location of area requested:
   (ex: 2AB South elevator landing outside cafeteria, outside ACB150)
2. Nature of function/event:
   • If other, please specify:
3. Type of sales involved/food served:
4. Benefiting organization/group/charity:
   • If other, please specify:
5. Amplification Equipment needed (speakers and microphone)?
   In House Equipment
   Outside Equipment

Requested Day(s), Date(s), Time(s):

Assistance:

Number of Chairs

Number of Tables

Set Up Time 1 hour before 1 day before

Clean Up Assistance Needed? Yes No

Housekeeping/Setup Assistance

**If special assistance is required, please check the appropriate box below and provide the details.

Audio Visual

(Please include details.)

Physical Plant

(Electrical or other assistance.)

Grounds Maintenance

(Set-up/restoration or other assistance.)

Health, Liability and Safety Responsibility:

The Sponsoring Organization understands and accepts full responsibility and provides assurances that the Request to Use TTUHSC Premises on the campuses of TTUHSC meets all health, financial, liability and safety requirements of the institution, city and county of the campus, lawas of the State of Texas and policies outlined in the Student Affairs Handbook, "Use of University Space, Facilities and Amplification Equipment" and HSC OP 61.07.

Student Organization President:

Faculty/Staff Advisor:

Department Head:

Department Head Email: