REQUEST FOR PERMISSION TO SERVE ALCOHOL

Campus:

Organization/Department.:

Date of Function: Hours: (from) (to)

Type of Function:

Location of Function:

Advisor/College Official(s) to be Present:

Number of Police Officers Required:

Type(s) of Alcohol to be Served:

College Administrator/Student Organization Advisor Responsible for Enforcing College Policy and Procedures for Serving Alcohol during the Function:

__________________________________ __________________________________

Signature Date

___________________________________

Title

Signature Approvals:

______________________________________ ___________________________

Assistant Vice Chancellor for Student Affairs Date

______________________________________ ____________________________

Chancellor Date

Form 1475/001 (2/09)