Application for On-Campus Activity / Conference / Short Course or Camp
REF: Executive Memorandum 93-103

To: Dean of Continuing Education & Summer School

Date of application:
From (name of applicant):
Department
WCU coordinator (this is the staff person responsible for the group while on campus):
Contact person (if other than the coordinator)
Sponsoring Division/Department:

Continuing Education Units Requested:


(Note: Residence Halls will be assigned according to needs and requirements of all groups. Preferences will be considered but not guaranteed.)

Course # (if applicable):
Semester hours requested:
Dates of Event:
Arrival date:
Approx. check-in time:
Departure date :
Approx. departure time:
Number of participants expected:
Average age :
Housing  

Is university housing requested?
Number of nights
Number of double occupancy rooms requested:
Number of single occupancy rooms requested:
Preferred residence hall:
(Placement of all groups will be determined by the Housing Office.)
Number of males (if known):
Number of females (if known):
Do you want linen?
If not for entire group, how many sets of linen do you require?
Food Serv ice
(All groups using university housing must participate in a meal plan.
First Meal:
Date:
Last Meal:
Date:
 
Function Number of Participants Dates Line Service or catered?
Breakfast
Lunch
Dinner
Banquet
Reception
Picnic
Please list any special meal requirements (i.e., boxed lunches):

Facilities. List all campus facilities the group will be using and the times:
Facility Date Time
1:
2.
3.
(NOTE: Reservations must be secured by the appropriate person prior to completing this form. edoutreach will not make facility reservations for your group. )
Physical Plant Requirements  
Special requirements for handicapped?
Explain:
Directional signs requested?
(If you need directional signs, you must place a work order with the physical plant.)
Other requirements (be specific):
Traffic Security Requirements  
Special requirement for auto parking?
Special requirement for bus parking?
Describe any special needs:
Billing  
Program funding source:
Account code:
Accountable officer's name:
Department:
Send bill to:
Program budget approved by accountable officer:


By checking "Yes," you are indicating that your accountable officer has approved the budget for this event and that your department is responsible for all expenses incurred.

   

 

 

For your records, please print this form before clicking "submit." Please click the submit button only once. You will not receive a confirmation page when you submit this form, but your request will be on its way to us. Thank you.