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 abbreviationsEvent Name*Please include your full chartered name; brief event description (ex. Student Government Association; Guest Speaker Dr. Bill Pieratt, DO)Type of Event* Introductory Meeting General Meeting Guest Speaker Wellness Community Service/Volunteering Academic Support Career Advising/Planning K-12 Mentorship Undergraduate/Pre-Med Mentorship Guest SpeakerFirst NameLast nameTitleLocation Ex. Dr. Bill Pieratt, DO Dean and Chief Academic Officer, Burrell College of Osteopathic MedicineTo 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 MentorshipName of School; Grade Level you will be working with (ex. Highland Elementary School; Grade 1) Undergraduate/Pre-Med MentorshipName 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.”This field is hidden when viewing the formWhere will this event take place? Burrell College Campus Off-Campus Online NM: Type of space requested (subject to availability): Seminar Room Lecture Hall Bear Den Multipurpose Room Outdoor Patio Lobby OMM Lab Simulation Lab SP Clinic Library Other 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 )Event Contact Name* First Last Event Contact Email* Enter Email Confirm Email Is the Student Organization President different than the Event Contact?* Yes No Student Organization President Name* First Last Student Organization President Email* Enter Email Confirm Email Event Date*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Event Start Time* : Hours Minutes AM PM AM/PM Event End Time* : Hours Minutes AM PM AM/PM Estimated Number of Attendees*This field is hidden when viewing the formExpected Attendees prev*Select All that Apply (Ctrl Click to Highlight Multiple)Burrell College Faculty/StaffBurrell College StudentsGuests under 18 years oldOther individuals not associated with Burrell College – please provide details belowExpected 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 ApplyOther AttendeesRoom Configuration Requested*Traditional Classroom Style – All Seats Face Towards PresenterU-Shaped Boardroom Style – Tables arranged in a U with the opening towards the presenterConference Room Style – Tables arranged to form a central large tableGroup Pods Style – Tables arranged to form small pods around the roomOther (Please describe in Setup section)SetupIf additional time is required for event set up and tear-down, please fill out the following.Setup Start Time : Hours Minutes AM PM AM/PM Setup End Time : Hours Minutes AM PM AM/PM Special Requests/Requirements/Other NeedsWill Refreshments be Served?* Yes No Audio Visual Support RequestsAll 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 GuidelinesDigital Signage Submissions: Drop files here or Select files 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 Δ