Special Event Request Form (Page 4 of 4) in pdf

10. Are you partnering with an outside organization for this event? YES

If so, which organization ___________________________________________________________________

Use of a student organization by an external company/organization to acquire event space and other benefits that a

recognized student org receives is strictly prohibited. Outside organizations must go through proper steps to securing space on

campus for an event as an “external guest to the University”.

Overall Points Total: ____________________

Based on the point total above, this event is:

Low Risk (No more than 15 points) *Medium Risk (15 – 29 points)

* High Risk (30 or more points)

*requires adviser signature

Additional points will be added by review committee for past history of unrealistic planning, violent conduct, or other

incidents by the organization or its members.

Points added: ___________

I warrant that I have the authority to make this agreement on behalf of my organization. I also warrant that by completing and

submitting this form, my student organization understands and agrees to abide by the terms and conditions of the EMU

Student Organization Special Events policy, the attached cover page, the EMU Student Code of Conduct, and all applicable

local, federal, and state laws. I acknowledge that my organization will accept full responsibility for timely payment (within 30

days of event date) of all university charges associated with this event. On behalf of the organization named above, I warrant

that my student organization and its members are not acting as official entities of the university and I agree to defend,

indemnify, and hold harmless EMU, its employees, agents and students from any and all liability which may incur arising

directly or indirectly from my student organization’s hosting of this event.

I understand that Medium and High Risk events could require DPS/Security to be present for either a portion of or the entire

event. Valid now for the 2014 – 15 school year, Campus Life will only cover estimated charges for security at events where DPS

is required or requested. If the final amount is more than the estimated cost, I understand that my organization is responsible

for the difference. Please note beginning in fall 2015, all DPS or security charges will be the responsibility of the host

organization.

(Required) Primary Event Contact Signature: ______________________________________________________

(Required) Organization President Signature:______________________________________________________

Adviser to Organization Signature: ______________________________________________________

Adviser Name:____________________________________

Phone number:_____________________

Email: __________________________________________

For Office Use Only

Date reviewed by Committee:______________

Event Approval Status: ____________________

Notification Date to Organization: __________________ Staff Initials: ______________

DPS required at this event?

YES

Estimate number of officers required: ____________

Campus Life Notified of DPS Charges for billing_________________(Initials)

DPS officer sign off for scheduling: _____________(Initials)

Date of planning meeting with venue manager: ______________________

Date of final pre-event meeting: _________________________ DPS notified of meeting date: Yes

Special Event Request Form Page 4