AY 2020-2021 COM-Student Event Request

Student Affairs

200 University Parkway, Suite 317

Yakima WA 98901

Phone: 509-249-7724

Fax: 509-249-7909
2020-2021 Student Event Request Form
Does you event include in-person contact? *

YES NO
EVENT REQUEST RISK ASSESSMENT

COMPLETE if your event involves in-person contact.
EVENT RISK ASSESSMENT
SUBMIT EVENT REQUEST RISK ASSESSMENT

Browse Files

Cancel of
Type of request: *

New Event Request Modified Event Request Cancel Event Request
IF you are modifying event, please describe type of change *
Contact Information

Please provide the name and contact information of the lead student for the activity/event.
Contact Name *

First Name Middle Name Last Name
Contact Phone: *

Area Code Phone Number
Contact Email: *
Secondary Contact Name (if applicable)

First Name Middle Name Last Name
Secondary Contact Phone

Area Code Phone Number
Secondary Contact Email:
Event Information
Type of event/activity: *

PNWU-COM SGA Event/Meeting PNWU-COM Club Event/Meeting PNWU-MAMS Student Event WSU Pharmacy Student Event WSU Nursing Student Event
Event/Activity Title: *
Event Description: 2-3 sentences - Please note: your event description may be used on the PNWU event calendar and other promotional materials on or off-campus if applicable. Please take this into consideration as you provide your description. Thank You. *
Event Start Date: *

Month Day Year Hour Minutes AM/PM Option
Event End Date: *

Month Day Year Hour Minutes AM/PM Option
What is the overall goal of the event/activity (for example: why is the club proposing this activity or what need is the club is trying to meet)? *
The activity/event will be primarily concerned with: *

Community Service Fundraising Professional Development Health/Health Services/well-being (social, emotional or financial) Education/Informational Ceremony/Celebration/Social
Will your club be fundraising during this event? *

Yes No
All fundraising events must also be approved by the PNWU Development Office.

Can our club fundraise for an organization other than PNWU?

Yes, fundraising may be conducted in support of an organization other than PNWU. All donations made to the designated organization must be made directly to the organization using the organizations website or having an organization representative at the fundraising event to physically collect donations. Checks to the organization need to be written directly to the organization and cannot be written to PNWU. An example of this type of fundraising effort is the annual Run for Your Life 5K.

Can our club fundraise on campus?
Yes, fundraisers on campus include things like t-shirt sales, mug sales, raffles or other methods of raising funds from the PNWU community of faculty, staff and students. Fundraisers must have PNWU Development Departmental approval PRIOR to the start of the fundraiser. Clubs must work with the PNWU Development Department using the new JustGiving platform.

See the 2020-2021 Student Handbook for fundraising approval procedure.

Per the PNWU Student Handbook:
All fundraisers must be submitted to Student Affairs for approval by using the Student Event Request and Summary form. Once the fundraiser has been approved, email development@pnwu.edu to receive written approval of your fundraising items. Student Affairs must receive this written approval before your event request can be processed. Students are responsible for turning in all monies earned to Student Affairs to be distributed into their individual club accounts. An SGA Fundraiser Deposit Form must be turned in with all monies raised within two weeks of the original date of the fundraising event. All club treasurers are responsible for tracking their individual club funds, and can check on any discrepancies with the SGA executive treasurer and Student Affairs.

What if I have more questions?
Please contact the Office of Development at development@pnwu.edu or Lauri Roberson at lroberson@pnwu.edu or 509.249.7874.
Will you be counting this as your Community Service Event?: *

Yes No
Club Information
Club Name *
If "Other" Please explain: *
Is your club sponsored or non-sponsored *
Please indicate if this event fulfills one of the annual club requirements: *

Service project that benefits the local Central Washington Community Service project that benefits the PNWU community Club fundraiser This event does not fulfill one of the annual club requirements
Name of Club Faculty Advisor *
If "Other" Please explain:
Does your club faculty advisor approve of your event? *

Yes No
Is your club the lead club for this event? *

Yes No
Please check all other clubs involved in this event. *

No other clubs were involved in this event Anesthesiology Biomedical Ethics CMDA Dermatology Diabetes Prevention Program Emergency Medicine Family Medicine Geriatrics Interest Group Global Health Club Grand Rounds Infectious Disease Internal Medicine LDSSA Medical Students Pride Alliance OB/GYN Oncology Pediatrics PM&R Prevention and Lifestyle Medicine Psych & Behavioral Health Radiology Reproductive Health SAA SAAO SAMOPS Sigma Sigma Phi SNMA SOMA Spanish Club Sports Medicine Surgery Veterans Club Washington Physicians for Social Change Wilderness Medicine Women in Medicine UGM
Please list in what capacity other club involvement in your event (ie: SOMA club was in charge of fundraising, etc.): *
Guest Speaker Information
Will you be having a guest speaker?: *

Yes No
Please explain guest speaker (include name, title, bio): *
Does your event include showing a documentary or other film?

Yes No
If yes, you will be required to obtain and provide documentation of public performance rights. If you already have this form, please submit it below.

If you have questions about this form, or how to obtain it, please contact Anita Cleary (acleary@pnwu.edu) or the PNWU Library (library@pnwu.edu).
Browse Files
Documentation of public performance rights. Cancel of
Clinical Information

Please Note: Clinical faculty must be present for the duration of the event in order for the event to be approved.
Is your event clinical in nature?: *

Yes No
Please describe any and all clinical procedures that are part of your event:
Name of clinical faculty member(s) who will be supervising your event:
If "other" please explain:
Participation/Guest Information
Estimated # of guests/participants i.e. 0-10, 10-15 etc. *
Will community members be invited? *

Yes No
Please explain community members/groups that will be invited, as well as their level of participation:
Venue Needs/Requests
First Choice room for your event: *
Second Choice room for your event: *
If "Off-campus" please explain:
Do you require any technical assistance for your event? *

Yes - Contact IT help desk at help@pnwu.edu No - Proceed to next question
If yes, please indicate the type of assistance or technology needs: *

Event set up assistance Event staffing Audio Computer login Laptop Projector Recording Video conferencing
Is this a recurring event? *

Yes No
If "Yes" please explain (e.g. list dates of recurring event):
Do you have facilities needs for your event? *

Yes No
If yes, please indicate the type of assistance: *

Food Set Up Classroom Furniture Move Move/Set Up Furniture Outdoor Setup Open/Close Walls Event Setup - Foyer
Please indicate equipment needed from Facilities: Note: additional rental fees may apply. The cost is $3.00 per table for additional tables and linens, and $0.50 per chair for additional rented chairs. *

Tables Chairs Linens Provide Garbage Cans BBQ Displays Easels Freezer Space Lectern Rolling Racks Rolling White Board Sprinklers Extension Cords (for potluck style events) Drop Cloths (for events with paint) N/A - No Extra Equipment Needed
Do you have Security needs for your event? *

Yes No
If yes, please indicate the needs: *

Guest Sign-In Off-Campus Security Off Hours Coverage - Weekend/Evening/Early Morning Coverage Parking/Traffic Control Street Signage Unlock/Lock Doors
Will you be providing food or non-alcoholic beverages at your event? *

Yes No
Type of Food to be Served: *

Appetizer Meal Snack Potluck - food will vary Non-alcoholic beverages only, no food
What food(s) will be served? *
ex. Pizza, Sandwiches, Catered Meal, Snacks
What food set-up is needed? *
ex. Extra tables, extension cords, garbage cans, linens
Are you requesting permission to serve alcohol at your event, or hold your event at a venue where alcohol will be available? *

Yes No
- Alcohol Use
  
  Alcohol use at the event requires prior approval by the Associate Dean of Student Affairs. Please complete the fields below for Alcohol use.
Type of Alcohol to be Served: *

Beer Wine Liquor
Type of Bar Provided: *

No Host Bar Hosted Open with limit
Alcohol Served by: *
Consumption Monitored by: *

Trained bartender and licensed and insured vendor. Faculty/Staff/Student organizer to handle both age verification and the service of alcohol. Copy of liquor license and insurance certificate attached. Copy of banquet permit attached (must be visibly posted during event).
If consumption is to be monitored by faculty/staff/student organizer, please list the name of the individual: *
The University may approve consumption of alcoholic beverages by individuals over 21 years of age at PNWU-sanctioned social, community outreach and public relations events. In these instances, general use of alcohol at the event must be preapproved by the University and moderate use of alcohol by employees at such events does not violate this policy. "Moderate Use" is defined as consumption that does not cause an employee to become disruptive, belligerent, argumentative, sloppy/unkempt appearance, slurring of one’s speech, inappropriate in personal interactions and/or behavior, or render the employee unable to operate a motor vehicle safely. For more information or to apply for a banquet permit, please see the WA State Liquor Control Board website.
Please describe your plan to provide safe transportation to participants (e.g., taxi cab phone numbers, uber, shuttle bus etc.): *
Liquor License (attach copy)

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Cancel of
Insurance Certificate (attach copy)

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Cancel of
Banquet Permit (attach copy)

Browse Files

Cancel of
Fundraising/Media/Communications Requests
Will there be fundraising at your event? *

Yes No
Fundraising Location(s): *

PNWU Off-Campus
If "Off-Campus" please explain:
All donations must be approved by the Development Department. You must have written approval of your fundraising items sent to Student Affairs before we are able to process your event request. Please email Lauri Roberson at lroberson@pnwu.edu to receive approval of your donation items.
Are you soliciting donations off-campus *

Yes No
Use of the PNWU logo or name on flyers, advertising, merchandise, fundraising items, clothing, etc. must be pre-approved by the Marketing & Communications Department. You must have written approval for the use of the PNWU logo sent to Student Affairs before we are able to process your event request. Please email publicity@pnwu.edu for approval.
If you have any marketing/communications needs (Print Materials, TV Displays, Digital or Web Design, Writing or other needs), you will need to complete the Marketing Request form - https://form.jotform.com/80455165600148

(this includes use of the TV Displays for promoting your events)
Do you plan to use the PNWU logo for any portion of your event? *

Yes No
Will there be PR or media interaction for this event? *

Yes No
Please explain "PR or media interaction": *
How do you plan to advertise this event? *

Flyer Newspaper Photography Press Release Radio Television Website Email
Any and all promotional materials must be approved by Student Affairs before posting. Flyers may be posted on approved bulletin boards only, and are not allowed to be posted on painted walls. Clubs are responsible for removing promotional materials in a timely manner.
Please upload any applicable documentation for your event request:
Any additional comments or special requests:
IMPORTANT! You will be contacted within 5 working days regarding approval of this event once you click “Submit Form.” Please note, if your event request is approved, you will be required to complete a Student Event Summary by the last day of the month following the date of your event.

You may access your Event request once you submit. A copy of the request will be emailed to the sender, so retain a copy of the email. If you scroll to the bottom of the email, and click edit request. You can cancel your request, modify your request, or submit your event summary.

If this is a club meeting, you do not need to fill out an event summary form unless you have a guest speaker at your meeting.
Agreement and Terms and Conditions:
- Room MUST be returned to pre-event configuration. Example: if room has desks in "lecture-style," but your event needs them in a circle, prior to leaving the room, you MUST return all desks to "lecture-style."
- Room MUST be left clean.
By clicking on the Submit button, you are agreeing to the above Terms and Conditions.
Should be Empty:

EVENT REQUEST RISK ASSESSMENT

Club Information

Guest Speaker Information

Clinical Information

Participation/Guest Information