METROPOLITAN COMMUNITY COLLEGE
COMMUNITY USER FACILITY REQUEST

REQUESTOR INFORMATION
First Name Last Name Date
Email Phone Fax
Billing Address:
Street City State Zip
Contact Person:
First Name Last Name
Email Phone Fax
Business or Organization For Profit: Yes No
Non-Profit 501 (c)3 #
EVENT DETAIL
Event Title
Event Description
Event Date Start Time End Time
Target Audience Estimated Audience
Requested Location: Building Room #
(If known)
Elkhorn Valley Campus N/A
Fort Omaha Campus Bldg. #
Swanson Conference Center
South Omaha Campus CON MHY ITC
SOC Express Center N/A
Applied Technology Center N/A
Fremont Center N/A
Sarpy Center N/A
Washington County Center N/A
Is your organization charging a participant fee? Yes No If yes, amount
Is your organization charging a vendor fee? Yes No If yes, amount
SERVICES REQUESTED
Audio Visual Set-up
Facility Set-up
Catering
(only available in the Swanson Conference Center)		 Alcohol Service Requested
(only available with catering)
Hosted bar
Cash bar
Public Safety Assistance
Other
For office use only
Approved Signature Date  

This is a request only and does not gurantee use of a facility.
Click Submit Request button, to submit your completed request form to MCC Events Office.