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
Student Event Request Form

There are many opportunities at PNWU to be involved with student events. Any student-organized event, whether it is held on the PNWU campus or off-campus in the surrounding community must be approved by Student Affairs. This includes, but is not limited to any club or SGA meeting, event, presentation, seminar, exhibit, fundraiser, guest speaker, workshop, certification course, volunteer experience, etc.

There is a limit of two events occuring at the same time. Therefore, there will only be two events allowed during the lunch hour and two events allowed after school hours. This does not include committee meetings or SGA meetings.

A minimum of two weeks is needed to process an event request. If less time is available please contact Lynn DeVore (ldevore@pnwu.edu) to determine if an exception is possible.
Type of request:*

New Event RequestModified Event RequestCancel Event Request
If you are modifying an event, please describe the change*
Request Type:*

EventSwag
Event Information
Type of event/activity:*

PNWU SGA Senate or Class MeetingPNWU Club EventPNWU-COM Student EventPNWU-DPT Student EventPNWU-MSOT Student EventPNWU-MAMS Student EventWSU Pharmacy Student EventWSU Nursing Student EventOther
Club Name*
If Club Name, Other, please explain
If more than one club is involved, please list details
Event Set Up time (if you need time to setup/prep, please tell us what time you need the room)

:HourMinutesAM/PM Option
Event Start Date:*

MonthDayYearHourMinutesAM/PM Option
Event End Date:*

MonthDayYearHourMinutesAM/PM Option
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.*
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)?*
First Choice room for your event:*
Second Choice room for your event:*
If "Off-campus" please explain:
Contact Name*

First NameLast Name
Contact Phone:*

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

First NameMiddle NameLast Name
Secondary Contact Phone

Area CodePhone Number
Secondary Contact Email:
The activity/event will be primarily concerned with:*

Community ServiceProfessional DevelopmentHealth/Health Services/well-being (social, emotional or financial)Education/InformationalCeremony/Celebration/SocialOther
Venue Needs/Requests
Do you require any technical assistance for your event?*

YesNo
If yes, please indicate the type of assistance or technology needs:*

Event staffingAudioComputer loginLaptopProjectorRecordingVideo conferencingMicrophoneOther
Is this a recurring event?*

YesNo
If "Yes" please explain (e.g. list dates of recurring event):
Do you have facilities needs for your event?*

YesNo
If yes, please indicate the type of assistance:*

Food SetupGarbage CansClassroom Furniture MoveMove/Setup FurnitureOutdoor SetupOpen/Close WallsEvent Setup - FoyerTable/Chair SetupOther
Please describe setup needed
Do you have Security needs for your event? (guests on campus, street signage, etc.)*

YesNo
If yes, please indicate the needs:*

Guest Sign-InOff-Campus Security (additional fee)Off Hours Coverage - Weekend/Evening/Early Morning Coverage (additional fee)Parking/Traffic ControlStreet SignageUnlock/Lock DoorsOther
Will you be providing food or non-alcoholic beverages at your event?*

YesNo
Who will be purchasing food for this event?

Student will purchase and be reimbursedPNWU Purchasing will purchase
Type of Food to be Served:*

AppetizerMealSnackPotluck - food will varyNon-alcoholic beverages only, no food
What food will be served?
ex. Pizza, Sandwiches, Catered Meal, Snacks
Are you requesting permission to serve alcohol at your event, or hold your event at a venue where alcohol will be available?*

YesNo
- Alcohol Use
  
  Alcohol use at the event requires prior approval by the Dean of Students. Please complete the Alcohol Request form: https://form.jotform.com/50545419344152 for approval to serve alcohol at your event.
Club Information
Name of Club Faculty Advisor:*
Does your club faculty advisor approve of your event?*

YesNo
Guest Speaker Information
Will you be having a guest speaker?:*

YesNo
Please explain guest speaker (include name, title, bio):*
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?:*

YesNo
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:*
Participation/Guest Information
Estimated # of guests/participants i.e. 0-10, 10-15 etc.*
Will spouses be invited?*

YesNo
Will community members be invited?*

YesNo
Please explain community members/groups that will be invited, as well as their level of participation:
Please upload mock-up of product from GO USA

Browse Files

Cancelof
Will tickets be sold using EventBrite?

YesNo
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 add this statement to every flyer:

If you need a reasonable accommodation for the event, please contact Ashley Bray, Director of Student Success and Disability Services (abray@pnwu.edu).
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:

Club Information

Guest Speaker Information

Clinical Information

Participation/Guest Information