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Northwest Missouri State University

Request to Use Alcoholic Beverages on University Property

Request must be submitted four weeks prior to the date of intended use.

All fields required.

Hosting Information

Phone Number:

Contact Information (the person primarily responsible for the event)

Phone Number:

Event Information

Date: (format: MM/DD/YYYY)
Start Time: (include a.m. or p.m.)
End Time: (include a.m. or p.m.)
Est. Attendance: (max)
Type of Alcohol Served:
Primary Attendee Type: Faculty/Staff
Age Range: (for majoirty of the attendees)

Does your group/organization require security at the event?
Yes    No

Has your group/organization had a security/police concern, incident and/or an action that has occurred at an event you have hosted in the past?
Yes    No

If yes, please explain:


Follow-up Meeting Date: (should be one week prior to event)

RESPONSIBLE PERSON AT THE ACTUAL EVENT: All persons attending the activity must comply with applicable federal, state and University regulations. I accept personal responsibility for ensuring that University policy and state laws governing the use of alcoholic beverages are complied with, and accept financial responsibility for the activity.

Legal Signature: