Application For Use Of Buildings, Facilities Or Grounds Form
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2Clear Form
Honolulu Community College
Application for Use of Buildings, Facilities or Grounds
Five (5) Work Days Advance Notice Required
Est. Attendance: _______________________ Bldg: _________________________ Room: ________________________
Date of Event: _______________________________________________________________________________________
Time: _________________________________________________________________________________________________
Day of Week:
M
T
W
TH
F
SAT
SUN
Purpose of Event: _____________________________________________________________________________________
______________________________________________________________________________________________________
For: ____________________________________________________________ Phone No: __________________________
(Name of Organization)
Address: ______________________________________ City: ______________________, HI Zip Code: _____________
Services Requested:
Air Conditioning
From: ____________am/pm To: _____________am/pm
Parking Passes
Amount needed: ___________________
Security
by Guards
by Applicant
Special Set-Up
(attach plan; 5 work days notice required)
Other: ___________________________________________________________________________________________
Media Service (attach media request form)
I understand that the facility is for instructional use only and must be left in its original condition. No
food or smoking is permitted. The use of intoxicating beverages on the premises is prohibited. All
damages to property, equipment, or facility which is a direct result of this event will be the
responsibility of the Applicant. Reimbursement for damages is expected within thirty (30) days. I
have read and signed the back page as applicable.
________________________________________ ________________________________________ ____________________
Applicant’s Name (Print)
Applicant’s Signature
Date
________________________________________ ________________________________________ ____________________
Coordinator’s Name (Print)
Coordinator’s Signature
Phone No.
Date
________________________________________ ________________________________________ ____________________
Assistant Dean/Dean/Director’s Name (Print)
Assistant Dean/Dean/Director’s Signature
Date
............................................................................................................................……......…………………………………..
Charges:
Facility Rental:
x _________hrs
= $_____________
Air Conditioning:
$______/hr x _______hrs x ____days
= $_____________
Security Overtime: __________________________________
= $_____________
Parking: _____________________________________________
= $ ____________
Others/Misc: ________________________________________
= $_____________
TOTAL
= $_____________
Approved by: _____________________________________________________________
_______________________
(Vice Chancellor of Administrative Services)
Date
Disapproved by:
.............................................................................................................................…….....…………………………………..
Copies:
Applicant
Apprentice
O&M
Cashier
Cafeteria
EMC
Security
Logged: ________________ /_________________
(OVER)
Rev. 11/04
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Parent category: Business