Loker Student Union | Event Plan Form

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General Info

Organization/Type*

Cultural & Identity Centers

Auxiliary

Campus Department

Off Campus

Organization Name*

Contact Name*

First Last

Pronouns

Primary Email*

Alternate Email

Phone Number*

Best Way to Contact*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Event Information

Please check YES or NO to the following statements regarding event details: (Additional fees may apply)

Title of Event*

Number of Event Days*

Event Date(s)*

Event Start Date(s)*

Event End Date(s)*

Recurrence Pattern*

Daily

Weekly

Monthly

None

Detailed Description of Program:*

Access Start Time*

Hours

Minutes

AM/PM

Access End Time*

Hours

Minutes

AM/PM

Event Start Time*

Hours

Minutes

AM/PM

Event End Time*

Hours

Minutes

AM/PM

** Additional charges may apply if Event and/or Access time exceed standard LSU Operating Hours.

Estimated on Campus Attendees*

Estimated off Campus Attendees*

Upload Any Additional Files/Sheets As Needed

Drop files here or

Max. file size: 50 MB, Max. files: 4.

Event Information

Please check YES or NO to the following statements regarding event details: (Additional fees may apply)

1. Will food be served?*

Yes – by Campus Catering

Yes – by Private Caterer (Fill out Exception for Campus Catering)

If yes, who is providing?*

Exception for Campus Catering Form (For on campus entities only)

2. Will Alcohol be served?*

Yes – If so, must order through Campus Catering.

3. Are registration, admission fees or donations being accepted?*

Yes

If yes, please specify amount:*

4. Is this event a profit-making venture (product showing, solicitation of goods or services)?*

Yes

5. Will this event be sponsored or promoted by a non-University or off campus organization?*

Yes

If yes, specify:*

6. Is this event co-sponsored by the LSU or on campus department?*

Yes

If yes, specify:*

7. Does this event directly relate to the educational mission of the University?

CSUDH Mission Statement

CSUDH’s Mission is to provide education, scholarship, and service that are both accessible and transformative. Learn how CSUDH supports this mission, the values that serve as our institutional pillars, our long history of educational excellence and our vision for the future of our university and the communities we support.

7. Does this event directly relate to the educational mission of the University?*

Yes

Not applicable – Private Event

CSUDH Mission Statement

8. Will there be a vendor fair or exhibitors as a part of this event?*

Yes

If yes, please specify no. of vendors/exhibitors:*

9. Will there be a guest speaker?*

Yes

If yes, please specify full name:*

10. Will media (DH Bulletin or news outlets) be notified about this event?*

Yes

If yes, please specify media outlets:*

11. Will filming occur during this event?*

Yes

If yes, please specify filming supervisor:*

12. Will this event include a film screening?*

Yes – If so, viewing rights must be provided before event can be confirmed.

13. Is this a Dance, Concert or Casino Night?*

Dance

Concert

Casino Night

None of the Above

See University Dance Policy

14. Will this event include amplified sound? (See Decibel Level Limits)

Decibel Level Limits

Outdoor Spaces (East Walkway): 70 dB
Outdoor Spaces (Other): 80 dB

14. Will this event include amplified sound?*

Yes

15. Will your event have decorations?*

Yes

If yes, please describe the decor:*

16. Will your event have Banners & Signage?*

Yes

If yes, please specify the quantity & sizing of each.*

17. Are you able to produce a Certificate of Liability Insurance?*

Yes – If required, sponsor must name The California State University, Dominguez Hills, Donald P. and Katherine B. Loker Student Union, Inc., its Board of Directors, officers, members, employees and agents, the California State University, Dominguez Hills, the State of California, the California State University Board of Trustees, and all of its other departments, boards, and commissions and its officers, employees and agents, are hereby declared to be the additional insured. The general liability limit must be of no less than one million dollars ($1,000,000).

18. Will your event require ADA accommodations? (Campus Departments Only)*

Yes

If yes, please describe.*

Event Spaces

Click Here to view Set-Up Styles we offer. If you do not see your desired set up, we can help you create a diagram for your event.

DHX (Open to Campus Departments Only) .

DHX

Preferred Room Set-Up Style(s)*

Preferred Room Light Color*

Preferred Backdrop*

White Backdrop.

No Backdrop

Ballroom Spaces

Ballroom Spaces

Ballroom A

Preferred Room Set-Up Style(s)*

Ballroom B

Preferred Room Set-Up Style(s)*

Ballroom A/B (Combined)

Preferred Room Set-Up Style(s)*

Ballroom C

Preferred Room Set-Up Style(s)*

Dominguez Ballroom (A/B/C Combined)

Preferred Room Set-Up Style(s)*

Pre-Function Space

Preferred Room Set-Up Style(s)*

All Ballroom Spaces

Meeting Spaces.

Meeting Rooms

Meeting Room 113

Preferred Room Set-Up Style(s)*

Meeting Room 130

Preferred Room Set-Up Style(s)*

Meeting Room 320

Preferred Room Set-Up Style(s)*

Meeting Room 322

Preferred Room Set-Up Style(s)*

Meeting Room 323

Preferred Room Set-Up Style(s)*

Meeting Room 324

Preferred Room Set-Up Style(s)*

Meeting Room 325

Preferred Room Set-Up Style(s)*

Meeting Room 324-325 (Combined)

Preferred Room Set-Up Style(s)*

Meeting Room 326

Preferred Room Set-Up Style(s)*

Meeting Room 327

Preferred Room Set-Up Style(s)*

Meeting Room 326-327 (Combined)

Preferred Room Set-Up Style(s)*

All Meeting Rooms

Outdoor Spaces – Other.

Outdoor Spaces

Palm Courtyard

Preferred Space Set-Up(s)*

North Lawn

Preferred Space Set-Up(s)*

Performance Stage

Preferred Space Set-Up(s)*

South Patio

Preferred Space Set-Up(s)*

North Patio

Preferred Space Set-Up(s)*

All Outdoor Spaces

Outdoor Spaces – East Walkway

East Walkway – Space 1

Preferred Space Set-Up(s)*

East Walkway – Space 2

Preferred Space Set-Up(s)*

East Walkway – Space 3

Preferred Space Set-Up(s)*

East Walkway – Space 4

Preferred Space Set-Up(s)*

East Walkway – Space 5

Preferred Space Set-Up(s)*

East Walkway – Space 6

Preferred Space Set-Up(s)*

East Walkway – Space 7

Preferred Space Set-Up(s)*

East Walkway – Space 8

Preferred Space Set-Up(s)*

East Walkway – Space 9

Preferred Space Set-Up(s)*

East Walkway – Space 10

Preferred Space Set-Up(s)*

East Walkway – Space 11

Preferred Space Set-Up(s)*

East Walkway – Space 12

Preferred Space Set-Up(s)*

East Walkway – Space 13

Preferred Space Set-Up(s)*

East Walkway – All Spaces

Preferred Space Set-Up(s)*

Other (Subject to additional approvals)

Please specify location if not listed.

Preferred Room Set-Up Style(s)

Additional Equipment

Listed are all the additional equipment we offer. Please select additional equipment, if needed. Note: Inventory is subject to availability.

DHX Only

DHX A/V Package (Flat Screen TV, Laptop, Presentation Remote)

Ballroom Only

Ballroom A/V Package (includes laptop, presentation remote, projector, and screen)

Meeting Rooms Only

Meeting Room A/V Package (includes computer, wireless keyboard/mouse, presentation remote, and projector)

Other Equipment

Microphone(s) – Wireless (Ballroom only)

Mic Stand – Table Top

Directional Sign Holders (11 x 17)

Flip Charts

Flip Chart Easels

Easels

Lectern (Ballroom only)

Mic Stand – Floor

Webcam

Conference Phone

Outdoor Soundsystem

LED Wireless Uplight(s)

Podium – Standing

Podium – Table top

Microphone(s) – Lavalier (Ballroom only)

Microphone(s) – All Purpose (Ballroom only)

Blu-Ray/DVD player

Mic Stand – Boom

Microphone(s) – Wireless (Portable)

Portable Soundsystem with Wireless Mic

Preferred Room Light Color*

Furnishings

Ballroom Chair(s)

Banquet Table(s)

Canopy with weights

High Chair(s)

High Cocktail table(s)

Low Cocktail table(s)

Meeting Room Chair(s)

Outdoor Chair(s) (steel)

Outdoor Table(s) (6′ x 3′)

Over-sided Burgundy Chair(s)

Portable Platform 6ft x 8ft – Stairs or Ramp (4)

Rectangular Table(s) (2.5ft x 6ft)

Seminar Table(s) (18in x 6ft)

Stanchions

Zero Waste Bins.

Wood Lounge Table

No of Stanchions*

Miscellaneous

Extension Cords

Dance Floor (Max size 16’ x 24’)

Power Strips

Additional Event Information

Does this event have programming activities such as food & beverage, guest speaker, performers, vendors, outside guests, minors?*

Yes

Is this event sponsored by a student organization except tabling events on the east and west walkways?*

Yes

Required*

Please complete this form and submit to riskmanagement@csudh.edu no later than 2 weeks prior to the event date.

*Do not complete the form for internal campus department meetings

State Fire Marshal (SFM) Permit Application

Will the event space be used in a manner that it was not originally intended or designed for. For example – a drive through distribution event in a parking lot, a speaking engagement at the gym, a programming event on the north lawn etc?*

Yes

Will the event have hot food preparation, tents or multiple canopies in use, stages or grandstands, temporary fencing, seating with more than 200 chairs? This is not an exhaustive list, please see the bullet above.*

Yes

Required*

Please complete this application for a State Fire Marshal (SFM) Permit.

Reservation Agreement

Please read and check off all statements before submitting.

Required*

I understand checking & signing this agreement gives me the responsibility to pass this information to either the main contact or the event contact of this event. I understand if the event contact or main contact is different from the reservation contact, the LSU needs to be informed. I understand that failure to come and sign my Reservation Confirmation after 2 business days from notification, will result in an automatic cancellation. I understand ALL events must be finalized NO later than 2 business days prior to the event date. I understand if no update on reservation request is received 3 business days after submitting Request Form, it is the sponsor/department’s responsibility to follow up with our office. I understand I, or my event contact, will need to check-in the day of the event, and ONLY I or my event contact can sign and/or make changes to the reservation. I understand my reservation must be canceled 2 business days prior to the event date, or it will be considered a No-Show. I understand that submitting requests less than 10 business days in advance does not guarantee my paperwork will be processed in time.

Please sign that you have read this agreement

Audited Reports	990 Forms
Audit Report (June 30, 2016)	Coming Soon
Audit Report (June 30, 2015)	Coming Soon
Audit Report (June 30, 2014)	Form_990_2014
Audit Report (June 30, 2013)	Form_990_2013
Audit Report (June 30, 2012)	Form_990_2012

Event Planner Form

General Info

Event Information

Event Information

CSUDH Mission Statement

CSUDH Mission Statement

Decibel Level Limits

Event Spaces

Additional Equipment

Reservation Agreement

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Richard McKee Transparency Act

Compliance Audit Reports

Financial Statements

Reservations & Event Services

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LSU Administration Office

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