Kenilworth Facilities Request Form

Student or Faculty/Staff(Required)

Student

Faculty/Staff

Name of Requestor

First Last

Requester's Email Address(Required)

Project/Class Associated with this Request

Professor/Advisor

Please provide us with the name of the professor or advisor with whom you’ve discussed this installation/filming.

Email of Professor/Advisor

Type of Work

(medium, material)

Start Date Requested

End Date Requested

Please note that requests over two weeks in length will require e-mailed justification from your professor/advisor.

Location

Room/area you wish to use. Please be specific.

Policy Details

The User agrees to comply with all applicable laws, regulations, and policies of the University of Wisconsin System, the University of Wisconsin-Milwaukee, and the Peck School of the Arts, including any policies pertaining specifically to the use of the Facilities. These include, but are not limited to, the following:

Policy Acknowledgement(Required)

I acknowledge and agree to abide by the policies listed above.

Acknowledge and Agree

Condition of Space Upon Exit(Required)

Please acknowledge that you will leave the space in as good a condition as when you began your install/filming.

Acknowledge and Agree

Restricted Materials

Please acknowledge the following: If affixing to a wall you must use blue painters tape or an approved fastener (check with psoahm@uwm.edu for approved fasteners). No fog, haze, glitter or pyrotechnics are allowed in PSOA spaces without the express written permission of the PSOA Facilities Director.

Acknowledge and Agree