ATTACHMENT IV

 

 

ALCOHOLIC BEVERAGE ACTIVITY

 

(Print) Name of Person Making Request____________________________________________________

 

Texas State ID#____________________________                        Date____________________________

 

If you are a university employee, please provide:

 

Name of Office/Department: ________________________________ E-mail _______________________

Phone ______________________ Is this a university sponsored event? ___Yes   ____No

 

 

If you are not a university employee please provide:

E-mail _____________________________ Phone__________________________

 

Address_________________________________________________          Phone____________________

 

TYPE OF ACTIVITY

 

____________   Departmental                            ____________   Closed Social              

____________   Student Organization                 ____________   Free __$______ Charge

____________   Residence Hall                          ____________   Open (ALL CAMPUS) Social

____________   Other (Specify)                          ____________   Free __$______ Charge

 

Type of alcoholic beverages to be made available: ___________________________________________

Type of non-alcoholic beverages to be made available: _______________________________________

 

DESCRIPTION OF EVENT_________________________________________________________________

 

DATE OF EVENT______________________________ TIME ___________ AM/PM to __________ AM/PM

 

LOCATION_________________________________________ ROOM ASSIGNED____________________

 

ANTICIPATED ATTENDANCE______________________________________________________________

 

The undersigned, in connection with the application to reserve a facility for the event described, certifies that (1) such function will not be restricted on the basis of color, age, disability, veterans’ status, sexual orientation, gender identity, and gender expression, race, religion, sex or national origin (see UPPS No. 04.04.46, Section 01.01), (2) such function will normally be restricted to university-related groups, (3) appropriate persons will be present at the function to ensure the proper use of the facility, (4) such function and use of the facility will not violate any law of the state or rule or regulation of the university. Furthermore the undersigned agrees to reimburse the university for any loss, damage, or expense incurred by the university as a result of the undersigned’s use of the facility, and is aware the university will not assume any liability for property damage or personal injury, including death, that may result from or during the undersigned’s use of the facility. Beverage servers must be present at all events in which alcohol is served and must be seller or server trained through a certified TABC school and possess a current and valid certification to dispense alcohol. University police officers must be present unless an exception is granted by the university.

 

 

 

Signature of Organization President:                              ________________________________________________

                                                                                   

                                                                                    Print_________________________ Date_______________          

                                                              

 

Signature of Sponsor:                                                   ________________________________________________

 

                                                                                    Print_________________________ Date_______________

                                                                                                                 

 

Signature of University Police Director/Designee:           ________________________________________________                                                                                                                                                           

                                                                                    Print_________________________ Date_______________

 

Number of Officers Assigned ______

                                                                                                                       

Signature of Facility Director/Coordinator:                      ________________________________________________                                                                                                                                                             

                                                                                    Print_________________________ Date_______________

                                                                                                                                                                       

Signature of Representative of

University Food Contractor (Chartwells)                          ________________________________________________                                                                                                                                                          

                                                                                    Print_________________________ Date_______________          

 

                                                                                                                                               

Signature of Dean of Students/Designee:                       ________________________________________________                                                                                                                                                          

                                                                                    Print_________________________ Date_______________

 

 

 

Contact Information:

 

Dean of Students Office

LBJ Student Center 512-245-2124

 

University Police Department

615 North LBJ-Nueces Building 512-245-8336

 

Chartwells-University Food Contractor

700 Moore Street-Harris Dining Hall 512-245-9930