Fillable Lihs Building Use Community Agency Request Form printable pdf download

Lihs Building Use Community Agency Request Form

Download a blank fillable Lihs Building Use Community Agency Request Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Lihs Building Use Community Agency Request Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

LIHS Building Use

Community Agency Request Form

Today’s Date: _________________________________

LIHS Center: _______________________

Organization Name: ___________________________

Center Manager:____________________

Organization Address: ___________________________

Center Address:_____________________

___________________________

______________________

Organization Phone#:___________________________

 Head Start  Early Head Start

Contact Person: ________________________________

A Completed Packet Will Be Forwarded To The

Center Prior To Event

Email Address: _________________________________

Type of Event:  Training  Meeting  Other

R equests for special events are due at least 4-6

Name of Event: __________________________________

w eeks prior to the requested event date/ time

and can take up 7-10 business days to process.

Date(s) of Event: ________________________________

An Approval Letter W ill Be Forw arded To The

Com munity Agency P rior To The Event

Event Time:

Setup Time

_________ to ________

Event Time

_________ to ________

Clean Up Time _________ to ________

Expected Number of Attendees:__________

Event Open To

 LIHS Staff  LIHS Families  Guests/Public  Organization Members

(Please Check All That Apply):

Please Provide A Brief Description Of The Event:______________________________________________

_____________________________________________________________________________________

Will This Event Be Advertised:  Yes  No

(Please Note All Advertisements Will Need Long Island Head Start Approval Prior To Posting)

Will Food/Beverages Be Served:  Yes  No

( Please Note At No Time Will Alcohol Be Allowed On Any Long Island Head Start Property)

Facilities Department Use Only:

Date Received:

Documents:

*(Requesting Organization Will Need To Provide: An Organization Letter of Request, A Certificate

 ADV

 INS

 HHA

of Liability Insurance, A Completed Hold Harmless Agreement and An In-Kind Donation Form)

INKF

Approvals

_________________________

Facilities Supervisor/Date

Director of Finance/Date

______________________________

_________________________

Director of Operations/Date

Director of Program Services/Date

_________________________

Chief Executive Officer/Date

Lihs Building Use Community Agency Request Form

Related Articles

Related forms

Related Categories