Kenilworth Event Usage 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/AdvisorPlease 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 MM slash DD slash YYYY End Date RequestedPlease note that requests over two weeks in length will require e-mailed justification from your professor/advisor. MM slash DD slash YYYY LocationRoom/area you wish to use. Please be specific. Policy Acknowledgement(Required)I acknowledge and agree to abide by the policies listed below. Acknowledge and Agree The User agrees to comply with all applicable laws, regulations, and policies of the University of Wisconsin System, the University of Wisconsin-Milwaukee, and Peck, including any policies pertaining specifically to the use of the Facilities. These include, but are not limited to, the following: Wisconsin Administrative Code Chapter UWS 18: Conduct on University Lands UWM Policy S-5: Alcoholic Beverages, Guidelines for Service UWM Policy S-23: Use of Facilities Policies and Procedures Peck Facilities Use and Access Policies 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 MaterialsPlease acknowledge the following: If affixing to a wall you must use blue painters tape or an approved fastener (check with email@example.com 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 CAPTCHANameThis field is for validation purposes and should be left unchanged.