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 *

Room Layout Instructions

Do you have an electronic drawing available of your desired room layout? *

If you select no, we will assume that you do not want any changes to the layout of the room you are requesting for your event and that you will be using the room AS IT IS CURRENTLY SETUP.

Special Instructions

Please include any special instructions or information in the space provided above.

Use the Browse button, to select your file from your local computer system; once selected click Upload button. A link to your Room Layout Drawing will be included with your form submission.

Room Layout Drawing Upload *

Files must be less than 2 MB.
Allowed file types: gif jpg png pdf doc docx.

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.

Are you prepared to upload a copy of your proof of such insurance at this time? *

You have indicated that you are unable to upload proof of your liability insurance at this time. Please provide this information 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 awall02@swmich.edu.

Use the Browse button, to select your file from your local computer system; once selected click Upload button. A link to your proof of insurance will be included with your form submission.

Proof of Liability Insurance Upload

Please upload a copy of your liability insurance.
Files must be less than 2 MB.
Allowed file types: gif jpg png txt pdf doc docx.

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

Clear signature

You may add your signature by using either a mouse on a computer or your finger/stylus on a touch device.

You are here

" alt="Southwestern Michigan College" />

SMC Preliminary Community Facility Request Form