Food Exemption Request
Date Received
______
Time Received
______
Organizations are permitted one food exemption per semester.
Requests must be submitted to the Student Life Office at the time of the room reservation
or a minimum of 14 days before event.
Organization Information
Organization:
_______________________________________________________________
Contact:

_______________________________________________________________
Address:

_______________________________________________________________
Phone:

__________________ Email:____________________________________
Event Date:
__________________ Time of Event: ___________________________
Building:

_____________________ Room: __________________________________
Number of Guests: _________________________________________________________
Rules and Regulations
Your group has requested a food exemption for an event. The rules and regulations for use of outside food in the
Ben Parker Student Center and the Student Recreation Center are listed below. If you fail to comply with these con-
ditions, future use of the facility by your group could be denied. If you are granted a food exemption for this specific
event, you acknowledge the following conditions:

Type of food and supplies list (please be specific and list everything you intend to bring):
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
 Only homemade food may be provided by your organization.



Initial ______
 No prepared food may be brought into the Student Center or Rec Center: Prepared food is defined as any food
items purchased in final form: vegetable trays, ethnic food from a restaurant, prepared food from a caterer, pizza,
snacks, etc. If you need clarification of the items you wish to serve, please meet with Conference Services for
assistance.










Initial ______
 Only homemade food may be sold as a fundraiser.





Initial ______
 All trash must be placed in an outside dumpster.





Initial ______
 All food and guests with food must remain in the assigned room.



Initial ______
 All food supplies must be provided by the organization (i.e., table clothes, napkins, ice, plates, salt & pepper,
utensils).










Initial ______
 There are no facilities available for heating/re-heating or food preparation.


Initial ______
 Damages to the facility or equipment will be the responsibility of the person signing below. Initial ______
 Student Life reserves the right the charge your organization a $75 fee.


Initial ______
Signing and submitting this form implies agreement to all policies and regulations as outlined above:

____________________________________


_______________________________

Signature of Organization Representative


Date





Submitting form does not guarantee approval; you will receive written notification.

Office Use Only
Room Request Approved in EMS? Yes / No Approvers Initials: _____ Reservation #____________
Request submitted within timeline?
Yes_____________________
No______________________
Menu submitted with request?

Yes_____________________
No______________________
Approved:



Yes_____________________
No______________________
Food Exemption Fee ($75)

Yes / No
If no, reason for denial:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Client notified:

Staff ____________________________
Date __________________
Authorizations:

Student Life

____________________________________
Date __________________

Campus Dining

____________________________________ Date __________________

Event Follow Up
Did group adhere to policies?

Yes_____________________
No______________________
If no, please provide documentation:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________