Activity Request Form

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OFFICE OF STUDENT ACTIVITIES Vinzons Hall Annex, UP Diliman QC ACTIVITY REQUEST FORM (STUDENT ORGANIZATION) Name of Organization Title

of Activity Brief Description of the Activity Date Filed Date of Activity

REQUESTS Posting of posters Posting of Tarpaulins Police Assistance Use of Univesity Facilities Other Requests Officer in Charge: Signature Name: Contact No.: Officially Recognized College-Based Student Organization __________________ College Secretary Recommending Approval:

Venue/Area

Time and Date

Noted by: Signature: Faculty Adviser Unit/ College Officially Registered University-Wide Student Organization __________________ OSA, Coordinator APPROVAL: __________________ Vice-Chancellor For Community Affairs __________________ Dean

__________________ Vice- Chancellor for Student Affairs Date:

Note/s:

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