Facility Use Request Form (last updated 05/2021)
Facility Use Request Form
Please e-mail completed form to Colette Richardson at corichard@indiana.edu and Dale Brand at
brandda@indiana.edu.
Contact Information
Requestor
Name ____________________________________________ Date ______/______/______
Phone ________________________ E-mail _____________________________________
Event Coordinator (if different from Requestor)
Name ____________________________________________ Date ______/______/______
Phone ________________________ E-mail _____________________________________
Clean-Up Coordinator (if different from Requestor)
Name ____________________________________________ Date ______/______/______
Phone ________________________ E-mail _____________________________________
Security Coordinator (if different from Requestor)
Name ____________________________________________ Date ______/______/______
Phone ________________________ E-mail _____________________________________
Clean-Up Coordinator, if different from Requestor, is responsible for removing all trash and
general clean-up after the event.
Event Information
Event Name ___________________________________________________________________
Sponsoring Ministry ____________________________________________________________
Brief Description of Event ________________________________________________________
______________________________________________________________________________
Number of Participants _______________ Number of Staff _______________
Does this event include children or provide childcare? Yes No
Date of Event ______/______/______ Start Time ___________ End Time ___________
Date of Set-Up ______/______/______ Start Time ___________ End Time ___________
Is this a recurring event? Yes No Frequency of event ____________________
Rooms and Equipment
Number of Rooms _____ Specific Rooms Requested ______________________________
Do you need access to the Media Booth in the Auditorium? Yes No
Include the quantity of each piece of equipment needed:
_____ TV (limited availability)
_____ VCR (limited availability)
_____ Music Stand
_____ Extension Cord
_____ Easel
_____ Chairs
_____ DVD Player (limited availability)
_____ Overhead Projector & Screen (1 available)
_____ Rectangular Tables or Picnic Tables
_____ Circular Tables (seats 8 people)
_____ Rolling Dry-erase Board (3 available)
_____ Other
Other Items ____________________________________________________________________
Facility Use Request Form (last updated 05/2021)
Kitchen Request
If you have a special request or questions regarding the kitchen,
please contact Colette Richardson at 812-824-2768.
Do you need paper/plastic products? Yes No
_____ Forks _____ Spoons _____ Knives
_____ Plates _____ Bowls _____ Cups _____ Other
Other Items ____________________________________________________________________
Event Promotion
Please provide information to Colette Richardson for church communications.
Would you like a table in the Atrium to promote this event? Yes No
Dates for Promotion: Start Date ______/______/______ End Date ______/______/______
The Facility Manager will work with you to determine the best location for your promotion table.
Please make sure to remove any materials or items that belong to you after the morning worship
service on the end date of your promotion table.
Table Size: 4 foot 6 foot Do you need a table covering? Yes No
Do you need an easel for a sign? Yes No
Will you be collecting: Food items? Yes No Clothing? Yes No
Do you need a collection bin? Yes No We will provide collection bins.
Is this event open to the public or for church only? Public Invited Church only
For events where the public is invited, this event will be published on Emmanuel social media.
Do you have graphics or materials to promote your event? Yes No
Do you need assistance recruiting volunteers/staff? Yes No
Please e-mail completed form to Colette Richardson at corichard@indiana.edu and Dale Brand at
brandda@indiana.edu.
