• Please submit your request at least TWO WEEKS in advance to allow for a timely processing. Check your email for confirmation. All confirmations will be sent by a Harambee House Staff Member.
• By submitting this form, you accept the terms outlined in the Harambee House Rules Document with special emphasis on the clean up and kitchen fine policies which were instituted on May 19, 2005.

Section A: Contact Information

Name of Person Making Request

Campus Address

Contact Phone Number

Sponsoring Organization(s) (list primary organization and then additional sponsors)

Today's Date

Section B: Event Information

Event

Event Date(s) in the following format MM/DD/YY

Actual Event Start Time (include a.m. or p.m.)

Event End Time (include a.m. or p.m.)

How much additional time is required to set up the space for the event?
No add'l time required 15 minutes 30 minutes 1 hour 2 hours 3 hours More than 3 hrs. - list in comments
Expected Attendance

Open to Public Yes No

Admission Fee Yes No

Person Responsible for Cleanup

Phone

Campus Address

If this event is ongoing or is a regularly occurring event, please fill in additional dates and times:
(Please note: The house can only be reserved for the current semester)

Space and Equipment Needed (check all that apply) :

Upper Living Room
Lower Level Den
Kitchen
Chairs
Television

Additional Comments: