Facility Use - Additional Information Form

Organization Name:
Contact Person Full Name:	*
Type of Organization:	--Non-ProfitFor-ProfitGovernmental Agency*
If Non-Profit, please attach a copy of your 501(c)3 status:
Is your organization student sponsored and student administered?	--YesNo*
If Yes, please explain:
Attendees will include:	--Adults OnlyOnly ICCSD StudentsMix of ICCSD Students and Non-ICCSD StudentsNon-ICCSD Students*
Will your event(s) sometimes charge admission?	--YesNo*
Does your organization/club charge the students to participate	--YesNo*
If proposed use is a political event, does the event intend to support or advocate for the election, re-election, or endorsement of a particular candidate?	--YesNo*
If your proposed use is a neighborhood association meeting or a neighborhood informational meeting, is the purpose of the event to advocate for the adoption of a particular viewpoint or to endorse a particular political candidate?	--YesNo*
First Name:
Last Name:
Phone:
Email:
Address:
Address:
City:
State:	--ALAKAZARCACOCTDCDEFLGAIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPAPRRISCSDTNTXUTVTVIVAWAWVWIWY
Zip:

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