Freedom of Expression Request

Main Contact Information

Name *

Firm/Organization *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Fax Number

Email Address *

Name *

Firm/Organization *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Fax Number

Email Address *

Request for *

Select all that apply *

Notification of large group (25+)

Use of amplification

Pyrotechnics

Affixment of materials to college property

Date of Event * +

Begin and End Time of Event

Begin Hour *

Begin Minute *

am/pm *

End Hour *

End Minute *

am/pm *

Area requested and/or structure to be used *

Number of anticipated participants *

Request Description - describe the event and your needs as specifically as possible *

Requestor's Signature *

clear

Date * +