Student Organization Event Request Form – Burrell College of Osteopathic Medicine Forms

Is this a Burrell College Student Group Request?*

Yes
No

Please use the form found here instead Building Use Request Form Thank you!

Student Organization*

Please list your fully chartered name, no acronyms or abbreviations

Event Name*

Please include your full chartered name; brief event description (ex. Student Government Association; Guest Speaker Dr. Bill Pieratt, DO)

Type of Event*

Guest Speaker

First Name	Last name	Title	Location

Ex. Dr. Bill Pieratt, DO Dean and Chief Academic Officer, Burrell College of Osteopathic Medicine

To accompany the event request, a guest speaker request form must be filled out for approval and submitted to the Office of Student Affairs. You may continue to complete the Student Organization Event request form.

K-12 Mentorship

Name of School; Grade Level you will be working with (ex. Highland Elementary School; Grade 1)

Undergraduate/Pre-Med Mentorship

Name of School; type of student you will be working with (ex. New Mexico State University; Biology Club)

Where will this event take place?

Burrell College Campus – NM
Burrell College Campus – FL
Off-Campus
Online

By choosing one or both campus options, you are indicating your request to reserve physical space at the selected campus(s). To reserve physical space at one campus and provide an online participation option for the other campus, choose both a campus option and “Online.”

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Where will this event take place?

Burrell College Campus
Off-Campus
Online

NM: Type of space requested (subject to availability):

FL: Type of space requested (subject to availability):

Seminar Room
Lecture Hall
Lobby
Conference Room
OMM Lab
Other

Other:

Does your organization plan to serve alcohol at this event?*

Yes
No

If the hosting student organization desires to serve alcohol at this off-campus event, approval must first be given by the Office of Student Affairs. For approval, submit a completed Alcohol Attestation to studentaffairs@burrell.edu.

Event Description to be displayed in LEO*

Please do not include any shortened urls in the event description. If a shortened url is needed, please include a space or parenthesis (ex: example(.)com/ example )

Student Organization President Name*

First Last

Student Organization President Email*

Event Date*

Event Start Time*

:

Event End Time*

:

Estimated Number of Attendees*

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Expected Attendees prev*

Select All that Apply (Ctrl Click to Highlight Multiple)

Expected Attendees*

Burrell College Faculty/Staff – NM
Burrell College Faculty/Staff – FL
Burrell College Students – NM
Burrell College Students – FL
Guests under 18 years old
Other individuals not associated with Burrell College – please provide details below

Select All that Apply

Other Attendees

Room Configuration Requested*

Setup

If additional time is required for event set up and tear-down, please fill out the following.

Setup Start Time

:

Setup End Time

:

Special Requests/Requirements/Other Needs

Will Refreshments be Served?*

Yes
No

Audio Visual Support Requests

All Burrell College meeting rooms have at a minimum a large format TV monitor with a wireless connection system which will accommodate most presenter laptops. While this system is suitable for most presentations – it may not support high definition video. Additional support / capabilities are available if needed. Please describe any additional requirements below. If presenter is using a Mac, some additional support may be required, so please indicate that as well.

Would you like your event advertised on digital tv signage?

Yes
No

Do you have your own Digital Signage image to submit, or would you like one to be created for you?

Submit
Created

Please include the details (Time, Date, Contact Information, etc) you would like featured on the Digital Signage:

Digital Signage Guidelines Overview
1. Size – 1280×720 / 1920×1080
2. Resolution – 72 ppi / 300 ppi
3. Background – Please do not make it predominantly white as it is a bit harsh to the eye.
4. Content – The most important information (title, date, time, and location) should be largest and prominent. The text should contrast well against the background (dark on light or light on dark, otherwise it’s difficult to read)

Full Digital Signage Guidelines

Digital Signage Submissions:

Drop files here or

Accepted file types: jpg, pdf, png, gif, psd, aippt, Max. file size: 8 MB.

Image must a ratio of 16:9, and a resolution of either 1280×720 or 1920×1080. If you have the working file, please submit that, Burrell College reserves the right to make changes to the submitted file .

A conflict of interest may exist if circumstances would lead a reasonable person to question whether motivations are for personal benefit and/or external interests. If you are aware of an existing, potential or perceived conflict of interest please disclose immediately to Jeremy Taulbee, Director of Student Life, jtaulbee@burrell.edu for mitigation efforts.

Marketing Requests:

Social Media posts (for Instagram make Burrell a collaborator):

Yes
No

Promotional Video:

Yes
No

Reserved for events open to the public only (ex. Health Fairs, 5K runs, etc.). Submissions are required at least one month prior to your event.

Burrell website mention:

Please provide a small write up of the event basics: who, what, when where, why)

Note: Marketing will cover events upon availability. If Marketing is unable to cover your event, please supply photos or video to salvarez@burrell.edu