Request for Use of Alcohol Form

Request for Use of Alcohol Form

I. POLICY:

THE USE OF ALCOHOL IN FACILITIES AND AT EVENTS UNDER THE SUPERVISION OF THE UNIVERSITY CORPORATION IS PERMITTED PURSUANT TO THE UNIVERSITY POLICY ON THE USE OF ALCOHOL AND ILLICIT DRUGS (http://www-admn.csun.edu/vp/policies/900_oversight/900_06.htm). ALL OTHER USE OF ALCOHOL IN UNIVERSITY FACILITIES OR OFF-CAMPUS AT UNIVERSITY SPONSORED EVENTS IS PROHIBITED UNLESS APPROVED BY THE APPROPRIATE VICE PRESIDENT (OR DESIGNEE), THE PRESIDENT'S CHIEF OF STAFF, OR THE EXECUTIVE DIRECTOR (OR DESIGNEE), OF THE UNIVERSITY CORPORATION, WHO SHALL CONSIDER REQUESTS FROM OFF-CAMPUS GROUPS.

II. PROCEDURE:

REVIEW THE UNIVERSITY POLICY ON THE USE OF ALCOHOL AND ILLICIT DRUGS PRIOR TO INITIATING THIS REQUEST. THE REQUEST FOR USE OF ALCOHOL FORM MUST BE SUBMITTED TO THE APPROPRIATE APPROVING OFFICER(S) NO LATER THAN 10 DAYS PRIOR TO THE EVENT. A COPY OF THE APPROVED REQUEST FORM MUST BE SENT TO THE DIRECTOR OF PUBLIC SAFETY AND THE UNIVERSITY RISK MANAGER PRIOR TO THE DATE OF THE EVENT, AND MUST BE KEPT ON THE PREMISES DURING THE EVENT.

III. EVENT INFORMATION:
• EVENT SPONSOR:	• DATE:	• DAY PHONE:
• EVENT REPRESENTATIVE:	• EMAIL:	• CELL PHONE:

• EVENT TITLE:	• EVENT PURPOSE:
• LOCATION:	• EXPECTED NO OF ATTENDEES: , INCLUDING
	STUDENTS	FACULTY	STAFF	PUBLIC
• NAME OF ENTITY TO WHICH AN ABC LICENSE HAS BEEN ISSUED FOR THIS EVENT, IF REQUIRED:
(PLEASE ATTACH A COPY OF THE LICENSE)
IV. ALCOHOL & NON-ALCOHOL TO BE SERVED:

• WHAT ALCOHOLIC BEVERAGES ARE YOU REQUESTING TO SERVE?

• ALCOHOLIC BEVERAGES WILL BE PROVIDED: NO COST FOR SALE

• WILL ALCOHOLIC BEVERAGES BE SERVED BY INDIVIDUALS WITH FORMAL TRAINING CONCERNING THE RESPONSIBLE SERVICE OF ALCOHOL? (e.g. TIPS PROGRAM)? YES NO

• IF NOT, EXPLAIN THE MEASURES THAT WILL BE TAKEN TO INSURE THAT ALCOHOL IS CONSUMED ONLY IN ACCORDANCE WITH UNIVERSITY POLICY:

• WHAT FOOD AND NON-ALCOHOLIC BEVERAGES WILL BE PROVIDED?

V. CERTIFICATION:
I HEREBY CERTIFY THAT I HAVE READ THE UNIVERSITY POLICY ON THE USE OF ALCOHOL AND ILLICIT DRUGS (http://www-admn.csun.edu/vp/policies/900_oversight/900_06.htm). I FURTHER CERTIFY THAT I WILL BE IN ATTENDANCE AT THE ABOVE EVENT AND WILL BE RESPONSIBLE FOR INSURING ITS COMPLIANCE WITH THE ALCOHOL USE POLICY.
*Signature of Responsible Event*
*Representative: ___________________________*	*Date: _________*

VI. APPROVALS:
*Dean or Director: _______________________________*	*Date: _________*
*VP/Chief of Staff: _______________________________*	*Date: _________*
*Executive Director, TUC: __________________________*	*Date: _________*