Community Support Form

Name:

Title (if any):

Organization (if any):

Email: *

Telephone: *

Address: *

Street Address City State ZIP Code

Project/Program/Event Name: *

Date & Time/Duration: *

Event Location (if other than ACSJL building):

Is this event open to the public?: *

Yes
No

Name & Email of Collaborators (if any):

Issue Area(s)

Social Justice Issues Addressed (check all that apply): *

Other Justice Issue (Enter below):

Provide a detailed description of your event/project (including speakers, agenda, format, etc.): *

What are the goals, outcomes, and/or action steps for participants?: *

How does this event connect to the ACSJL's work (mission & social justice definition)?: *

How will you share the outcomes with the ACSJL (photos, sign-in sheets, action steps)?: *

Comments/additional information:

Building Use Requests

Name, Email, & Phone of K College Host (A current K Staff or Faculty Member is required to be onsite after normal hours):

Event Date:

Duration of Project:

Estimated number of attendees:

Setup Time:

Start Time:

End Time:

Room Information:

Whole building (140 capacity)
Large Seminar South Wing (40 capacity)
Small Seminar North (13 capacity)

Setup Information:

Comments/additional information:

Note: Group hosts are responsible for their own setup & clean up. Groups may be subject to a charge if additional set up & take down is required.

Audio/Visual:

Comments/additional information:

Will the event be catered?:

Yes
No

Requests for Kalamazoo College’s Dining Services can be made at catering@kzoo.edu

Caterer:

Caterer Telephone:

Funding/In-Kind Support Requests:

Total Amount Requested from the ACSJL (typical cosponsorships range from $100-$300, with an annual cap of $500 per organization). Please put detailed expenses below):

Expenses (include dollar amount and description for each individual expense):

Funding from other sources (include dollar amount and description for each individual expense):

ACSJL Staff Support Requests:

Number of Full Time Staff Needed:

Number of Student Fellows Needed:

Total Hours (est.):

Names of specific staff, if known:

Who would you like to do the following tasks? (Please select one for each task)

Contact/confirm speaker arrangements:

ACSJL staff
Host Org/Group (you)

Collect RSVPs:

ACSJL staff
Host Org/Group (you)

Provide/arrange media equipment & furniture set up:

ACSJL staff
Host Org/Group (you)

Create & post flyer (also share electronic copy with ACSJL staff):

ACSJL staff
Host Org/Group (you)

Create & share social media event page:

ACSJL staff
Host Org/Group (you)

Write & distribute press release:

ACSJL staff
Host Org/Group (you)

Write & distribute press release:

ACSJL staff
Host Org/Group (you)

Conduct outreach to partners:

ACSJL staff
Host Org/Group (you)

Order Catering:

ACSJL staff
Host Org/Group (you)

Prepare printed materials/handouts for event:

ACSJL staff
Host Org/Group (you)

Purchase other materials/supplies:

ACSJL staff
Host Org/Group (you)

Take photos at event:

ACSJL staff
Host Org/Group (you)

Collect & distribute evaluation sheet:

ACSJL staff
Host Org/Group (you)

Other Duties Not Listed:

Arcus Center for Social Justice Leadership