SMC Preliminary Community Facility Request Form

Contact Information

Organization *

Contact Person *

Title *

Street *

City *

State *

Zip Code *

Phone Number *

Phone Number, part 1

Phone Number, part 2

Phone Number, part 3

Fax Number

Fax Number, part 1

Fax Number, part 2

Fax Number, part 3

Email Address *

Event Information

Name of Event *

See Event Promotion section below for additional details on where the text you enter here may be used.

Number of Participants/Seats *

Electronic Equipment Requirements

Do you require any audio, visual or computer equipment for your event? *

Please check off any audio, visual or computer equipment you will need for your event.

Electronic Equipment Selection *

Blu-ray/DVD Player

Mounted Projector (Full size HDMI ports available for personal devices)

Sound System

Presentation Computer

Laser pointer clicker

General Classroom AV (Windows 10 Computer, Projector, Blu-ray/DVD Player and Sound capability)

Electronic Equipment Other

Please describe any additional electronic equipment that you need for your event in the space provided above.

Room Layout Instructions

If you have any special instructions for the room layout, please enter them in the box below. If you have a room drawing, please email it to maintenance@swmich.edu.

Liability Insurance

Southwestern Michigan College requires that any organization who uses our facilities have liability insurance in effect during the time frame of this event. SMC must receive proof of this insurance coverage prior to your event.

Please provide Liability Insurance via one of the following methods prior to your event:

U.S. Mail: Send a copy of your proof of insurance to Southwestern Michigan College, Buildings and Grounds Department, 58900 Cherry Grove Road, Dowagiac, Michigan 49047;
Facsimile: Send your proof of insurance via facsimile to the Maintenance Department at Southwestern Michigan College at 269-782-1394; or
Email: Email proof of insurance to Andrea Wall, Administrative Assistant for Buildings and Grounds at Southwestern Michigan College at maintenance@swmich.edu.

General Comments/Questions

Additional Comments

Please enter any additional questions or comments in the space provided above.

Use of Facilities Policy Acknowledgement

The submitter of this form (who is 18 years of age or older) acknowledges or organization agrees to be responsible for the use of the premises, including the actions of those in attendance at the event. The submitter and/or the organization agree to indemnify and hold harmless Southwestern Michigan College, its officers, agents and employees against all claims, demands or causes of action against them for property damage and/or personal injury arising out of the use of the College facilities by the undersigned even if such claims, damages or causes of action allege negligence or other fault on the part of the College, its officers, agents or employees. Further, the submitter agrees to indemnify the College for any damage to College property arising out of the use of the College facilities by the submitter or organization.

By inserting my signature in the space provided below, I acknowledge that I have read Southwestern Michigan College's Use of Facilities Policy and agree that the use of said facilities will be in accordance with the terms and conditions outlined in this policy.

Acknowledgement Signature

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SMC Preliminary Community Facility Request Form