Title of Event: ______________________________________________________________________

Purpose: ___________________________________________________________________________

Responsible Party: ___________________________________________________________________ (Must be the name and title of the responsible party and/or host of the event.)

Contact Information: Office: _____________ Home: _____________

Cellular:_____________ Fax: _____________ Other: _____________

Location of the Event: _______________________________________________________ (If the event is held on Recreation Center or University Housing property, please forward a copy of the signed form to Auxiliary Enterprises.)

Date: _____________ Time: from ________ pm until ________ pm

Number of Guests Expected: Total _____ Faculty _____ Students _____ Staff _____ Guests _____

Please provide short answers or circle appropriate answers as indicated to the following questions:

What steps will be taken to assure that alcoholic beverages will not be served to minors?

ID Badge Check

Hand Stamp

Tickets

Other ____________

What steps will be taken to regulate the serving of alcohol?

Tickets

Hand Stamp

Cash Bar

Other ____________

What steps will be taken to prevent the serving of alcohol to intoxicated persons (e.g., responsible party will monitor attendees' intake)?

_________________________________________________________________________________________

Will non-alcoholic beverages and food be provided?

_________________________________________________________________________________________

Will security be provided by the host facility? If not, what provisions will be taken to assure security measures (e.g., if more than 15 attendees are expected, UT Police should be advised)?

_________________________________________________________________________________________

Submitted by: ___________________________________ Date: __________ (signature of responsible party)

Endorsement: ____________________________________ Date: __________ (if applicable, dean or vice president)

Approval: _______________________________________ Date: __________ Chief Financial Officer or designee

Submit toAVP, Financial Resources via email, by interinstitutional mail to UCT 901, or by fax at 713/500-4955.

CFO Use Only

Sponsor Advised: __________________________________ By: __________

Updated 5/01