Division of Housing and Ancillary Services at Western University


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CAMPUS ALCOHOL POLICY FORM
Event Proposal for Non-Students
(Staff, Faculty and Graduate Students)


Fields with * are required.    
Submitter *
Address *
Telephone * -
ex. (519)111-2222
Email *


   Organizer is the same as the submitter    
Name of Organization *
Address *
Telephone * -
ex. (519)111-2222
Email *

EVENT  
Date of Event *
Venue * Wave   Spoke   Grad Club   Labatt Lounge   Off Campus
  Name of Off-Campus Establishment
Be sure to complete the Description of Event AND Off-Campus Event sections.
Description of Event *

Include: Theme or purpose, activities or programming plan; start, end times; number of participants; supervisory personnel and volunteer monitors (see additional information section); Smart Serve Certified personnel; First Aid Certified personnel; etc.
Number of Participants *
people
Additional Information About Off-Campus Event *

Be sure to mention: Smart Serve (CAP 9(a); describe the type and quantity of food and non-alcoholic beverages (CAP 9(c) (d); cash bar tickets, BYOB? (CAP 9(f); extra strong/extra large drinks, shooters, kegs, special deals CAP 9(e)).
Transportation: (complete for on-campus AND off-campus event) *

Complete for ALL events. Be sure to mention: how participants will arrive and depart; transportation provider (attach confirmation); number of buses; pick-up/drop-off times and destinations (both ways); identify bus monitors; care plan for the intoxicated (on-campus/off-campus residents); etc.
Additional Information: Use this space to provide other information to help understand your event.
Compliance with Alcohol Policy
Will persons under age 19 attend the event? *


        * Answer these questions only if you selected Yes
        How Many?
        What controls will prevent underage consumption of alcohol?
        
 

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Last Modified on October 20, 2017 3:30 PM, by [DR]