Residential Life/Learning Communities Tabling, Donation and/or Collection in Residence Hall(s)/Student Townhome Application

Please use this form to apply to collect for donations, tabling or other activities with residence hall(s) and/or Student Townhomes.

Please note that completing and submitting this form is an application and it is not approved until Residential Life/Learning Communities confirms via email that it is approved.

Please request no fewer than 7 days before you are proposing to start. This allows time for communication, material delivery, notification to staff and students.

First Name & Last Name of person completing this form: First Name & Last Name of person completing this form: First Last
800 Number of person completing this form
Must be 9 digits. Currently Entered: 0 digits.
Phone Number of person completing this form: Phone Number of person completing this form: - ### - ### ####
Email Address of person completing this form:
Group, Class or Organization you're request is on behalf of
Name of faculty/staff advisor Name of faculty/staff advisor First Last
Email of faculty/staff advisor
The request is to:

The request is to: Place a collection box in residence hall/student townhomes Table in residence hall/student townhomes Other Other
Goal or Mission of your tabling/collection
Information about your collection/donation that can be copied and pasted to residential students to help your goal or mission
Please upload any advertisements used (if any)
maximum 5 files whose total size may not be more than 10MB
filenames should not contain more than one period (.)
Which residence hall(s) and/or student townhomes are you asking to be involved?

Which residence hall(s) and/or student townhomes are you asking to be involved? Thompson Hall McLean Hall MacVicar Hall McFarlane Hall Harmon Hall Gordon Hall Dobson Hall Perry Hall Briggs Hall Bramley Hall Eagle Hall Student Townhomes
Proposed date to start tabling/collection Proposed date to start tabling/collection / MM / DD YYYY
Proposed time to start tabling/collection Proposed time to start tabling/collection : HH MM AM/PM
Proposed Date to end tabling/collection Proposed Date to end tabling/collection / MM / DD YYYY
Proposed time to end tabling/collection Proposed time to end tabling/collection : HH MM AM/PM
What is your proposed plan to deliever boxes, materials, etc. to each residence hall or student townhome you are requesting?
I/My Organization understand of the Expectations:

I/My Organization understand of the Expectations: I understand that I/my organization is responsible for managing the table/box and providing all associated table/material. Residential Life/Learning Communities is supporting by providing space but not management or supplies
I/My Organization understand of the Expectations:

I/My Organization understand of the Expectations: I understand that myself or my organization is responsible for collecting items in a timely fashion and coordinating pick-up access to the residence halls with that individual resident director. *Items not collected the day after the collection is completed may be removed from the halls by facilities/residential life staff.*
I/My Organization understand of the Expectations:

I/My Organization understand of the Expectations: I understand that if at any point the table or collection becomes disruptive, encroaches upon student’s living space, or otherwise violates this agreement, that permission may be revoked at the discretion of Residential Life/Learning Communities staff
I/My Organization understand of the Expectations:

I/My Organization understand of the Expectations: Submit information and advertisement information via this form to be used to communicate with students
I/My Organization understand of the Expectations:

I/My Organization understand of the Expectations: Students are not permitted to enter residence halls or student townhomes who do not live there.
I/My Organization understand of the Expectations:

I/My Organization understand of the Expectations: Collections/Donations can not be solicited by going door to door in residence halls or student townhomes.
I/My Organization understand of the Expectations:

I/My Organization understand of the Expectations: I understand that completing and submitting this form is an application and it is not approved until Residential Life/Learning Communities confirms via email that it is approved.
I/My Organization understand of the Expectations:

I/My Organization understand of the Expectations: I/my organization has reviewed the Code of Student Conduct (https://www.brockport.edu/life/student_conduct/) and the On Campus Housing License (https://brockport.edu/life/residential_life/policies/) and understand that any alleged violations of these documents may be addressed by Student Conduct