University Student Affairs – California » Community Service Request Form

Event Information

Name of Event*

What is the name of the organization putting on the event?*

Briefly tell us about your organization/event.

What is the street address of the event?*

Building Name

City*

My event is a:*

Single-Day Event
Multiple-Day Event

Event Date*

End Date:*

What time does the event start?*

:

What time does the event end?*

:

What is the deadline for students to respond to you?*

Contact Information

Name of person for questions/sign up?*

Email address for contact person?*

Telephone number for contact person?*

Planning Information

What is the primary language(s) spoken by attendees?*

Check all that apply.

Expected Number of Attendees*

What services are you requesting?*

Check all that apply.

Additional Services:*

What supplies will you provide to the WesternU volunteers?*

Advertising
Chairs
Medical Supplies (Gloves, etc.)
Signage
Tables
Tents/Shade
Other

Additional Supplies Provided*

Contract

Do you have a contract that must be signed by a University representative?*

If yes, it must be reviewed by our legal department.

No. A contract is not necessary
Yes. I will upload my .pdf contract now
Yes. I will e-mail contract to studentaffairs@westernu.edu

Please upload contract here.*

Only .pdf files accepted.

Accepted file types: pdf, Max. file size: 125 MB.

Comments

Please provide any other information about the event that students may need to know.

I hereby acknowledge (please initial):

1. We will make our students aware of your event and encourage them to participate, but we unfortunately cannot guarantee that they will be available for your event.*

2. If students are able to participate, they will communicate directly with the “who to contact” person.*

3. If your event is taking place in December, May, June, July or early August it is highly unlikely students will be available to participate as they are either in heavy exams or on break.*

4. A WesternU faculty member or preceptor must oversee students performing screenings for insurance purposes.*