Program Request

Today's Date:
*Sponsoring Organization (represents who is legally responsible for this proposed event):
 
*Contact Person (legally responsible for event):
 
*Mailing Address:

*Day Phone:   Cell Phone:   Fax:
*E-mail:

Please provide as much information as possible. If you have questions, call 419.372.2642.

*Brief description of the activity or event you are planning:

*Total number of activity/event dates you are requesting:  

If you are requesting a RANGE of dates, with no specific date requirement, please complete this section. If you are requesting SPECIFIC dates, proceed to the next section and complete the ACTIVITY/EVENT REQUEST details.

Please click on the days of the week you are interested in:

      Mon Tue Wed Thu Fri Sat Sun

The earliest available date for activity:
The latest available date for activity  :
The length of time for programming request: hours

If requesting SPECIFIC date(s), please complete this section. 

Activity/Event Request #1

Day/Date:

Time(s) desired:

The length of time for programming request: hours

*Anticipated number of BGSU student participants (do not include spectators):
*Anticipated number of non-BGSU participants (do not include spectators):

*Check each activity requested

 Cross-Cultural Communication
 NCBI
 Safe Zone
 Other Activity (please specify):

*What are you primary goals for the diversity initiatives? Please explain:

*What other initiatives are you seeking to understand and appreciate diversity on campus and/or in the community? Please explain:

Any additional information? Please provide special set up needs, additional date explanations or any other pertinent information.