Office use only

Date received

ABRAHAM BALDWIN AGRICULTURAL COLLEGE

Inter- Activities Council

Program Request Form

This form should be submitted to the IAC at least two weeks prior to the actual program. Please be aware that you may not advertise the event or solicit for the event until this form is returned to you with the appropriate approval signatures.

NAME OF ORGANIZATION: __________________________________________________________________________________

NAME OF PERSON FILING THE REQUEST:

____________________________________________________________________________________________________________

Name                                                                                                      Position                                                                 Phone Number

ADVISORS OF THE ORGANIZATION:

____________________________________________________________________________________________________________

Name                                                                                                                                                                                      Phone Number

TYPE OF PROGRAM: ________________________________________________________________________________________

PROPOSED BEGINNING AND ENDING DATES & TIMES OF PROGRAM:

____________________________________________________________________________________________________________

OBJECTIVES OF THE PROGRAM: _____________________________________________________________________________

____________________________________________________________________________________________________________

IS THERE A SPEAKER? ______________________ NAME__________________________________________________________

AFFILIATION: _____________________________________________ PHONE NUMBER: ________________________________

DETAILED DESCRIPTION OF THE PROGRAM REQUIREMENTS (Example: location, charges, materials, expenses, hours of operation, sales and collection procedure, publicity, manpower required, etc.):

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

FINANCIAL RESPONSIBILITIES (Example: Cost of the Program, etc.)___________________________________________________

STATEMENT OF AGREEMENT TO FINANCIAL CONDITIONS:

We ___________________________ agree to assume all financial liabilities by the above stated program on an equal basis.

_____________________________________                          ____________________________________

APPROVED          DENIED SIGNATURE

_________           _________           ____________________________________

                                                                IAC PRESIDENT

_________           _________           ____________________________________

                                                                IAC ADVISOR

_________           _________           ____________________________________

                                                                DIRECTOR OF STUDENT LIFE AND HOUSING