Student Organization Name * Student Representative Name(s) * Cell Phone Contact Number(s) * Penn State E-mail Address(es) * Which category best describes your program? * Community Service Cultural/Diversity Educational Entertainment/Novelty Fundraiser Social Other Name of Program * Proposed Location of Program * For example - Swimmer Hall, Eberly 102, etc. Please note, spaces on campus must be reserved in advance. Student Affairs will confirm availability. (For fundraisers - location can simply be, "all over campus.") Date of Program * If this is a fundraiser request, list the day/date range you would like the fundraiser to be or anticipate the fundraiser to be (for example: 30 days or October 1 through while supplies last, etc) Description of Program * Please be as specific as possible. The more details you include about your program request, the better. If this is a fundraiser, include links if applicable. Describe what you will be selling. For complicated or unique requests, the Office of Student Affairs will request a meeting with you to further discuss your event. Will campus services such as maintenance and technicial equipment be needed for your program? * Yes No Unsure If yes, please describe in detail what is needed. For example: 3 tables, 10 chairs, 2 microphones, etc... For large scale requests, Student Affairs will request a meeting with you to discuss your event. Math question * 9 + 2 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.