Staff Use of Facilities Form Directions

  1. Complete all highlighted areas on form.

Not filling out all information can delay your event request.

  1. If you are using any AV equipment fill that portion of the form also.
  2. If you are using the Performing Arts Center (PAC) please fill out the bottom portion of this form we need it for scheduling your event.
  3. Send to your Dean or Manager for signature.
  4. After signed by your Dean or Manager please send to me for scheduling.
  5. Please Note: There may be staffing charges if using the PAC.

If you have any questions when filling out the form please call me at ext. 22055

Thank you

Nancy Tolton

DIABLO VALLEY COLLEGESTAFF USE OF FACILITIES

Did you put this in the 25LIVE?

This form is to be used to request use of facilities, media services, theatre services, and room arrangement for special events.

Draw a diagram of the desired arrangement in the below box.

DVC EVENT COMMUNITY EVENT

Organization or Class / Today’s Date:
Event: / Requested Room(s):
Name of Requestor: / Home Phone: / Dept. / Ext.
CONTRACT NAME: / Contact #:
HOW MANY ATTENDING: / ACTUAL START TIME OF EVENT:
Indicate day(s), and times of use:
(Circle one) / Day: M T W TH F SA SUN / Date(s)
From: / To:
SPECIFIC DESCRIPTION OF SERVICE DESIRED / DIAGRAM OF ROOM ARRANGEMENT
N
W E
S
Will refreshments be served? / YES NO
Dean/Manager / Director of Maintenance and Operations
PLEASE FILL OUT ALL INFORMATION BELOW IF YOU NEED EQUIPMENT FOR YOUR EVENT
SPECIAL EVENTS REQUIRE AN OPERATOR
1. / AUDIO REQUIREMENTS:
PLAYBACK
CD RECORD
No. of MIC(S): / CD
YES
KIND: / MP3 Player
NO
OTHER Format
(If you are keeping the recording, you MUST provide a blank CD’s)
2. / VIDEO REQUIREMENTS:
TV Monitors
Playback
Record? / 1
DVD
YES / 2
VHS
NO
OTHER Format
(If you are keeping the recording, you MUST provide a blank CD’s)
3. / PROJECTION REQUIREMENTS:
LCD SLIDE OVERHEAD
4. / LAPTOP: (You are responsible for providing a laptop and operating it)
I will be using:
MAC PC Internet Connection
Purpose of computer:
Internet Browsing PowerPoint Playing a DVD/CD
5. / EASEL(S) and SCREEN(S):
Number of Easel(s):
There are screens in most rooms. A screen will be provided where indicated from your projection requirement and/or Room Arrangement
(PAC) PERFORMING ARTS CENTER REQUIREMENTS:
REHEARSAL DATES: / AV OPERATOR NEEDED / DAY / SET-UP
TIME / REHEARSAL
START TIME / REHEARSAL
END TIME
YES NO
YES NO
YES NO
YES NO
PERFORMANCE DATES
MONTH and DAY: / DAY / SET-UP
TIME / PERFORMANCE
START TIME / PERFORMANCE
END TIME