REQUEST FOR PERMISSION TO SERVE ALCOHOLIC BEVERAGES
EXHIBIT A8
NAME OF REQUESTOR: EXT: M/S:
REPRESENTING WHAT GROUP:
IF A NON-UNIVERSITY GROUP CO-SPONSORING, SPECIFY
GROUP NAME AND CONTACT INFORMATION:
EVENT FOR WHICH ALCOHOL IS REQUESTED:
BUSINESS PURPOSE FOR EVENT:
DATE OF EVENT: TIME BEGINS: TIME ENDS:
LOCATION: EXPECTED ATTENDANCE (NUMBER):
EXPECTED ATTENDEES: FACULTY STAFF STUDENTS
NON-UNIVERSITY (SPECIFY GROUP)
TYPE OF ALCOHOL REQUESTED:
CERTIFICATION: As the UTD representative responsible for this event, I understand that I am to be present for the entire event
and that there is a Texas Alcohol and Beverage Commission (TABC) licensed server/bartender to assure that no alcoholic beverage
is taken out of the designated area, that no individual under the legal drinking age is served, and that food is available.
RESPONSIBLE UNIVERSITY REPRESENTATIVE (NAME ):
(TITLE):
SIGNATURE: ________________________________________________________ DATE:
________________________________________________________
REQUESTOR (DEAN, DIRECTOR OR ABOVE) DATE
________________________________________________________
SPACE/ROOM APPROVAL DATE
________________________________________________________ PERMISSION GRANTED
PRESIDENT’S DESIGNEE (ASSOCIATE VP FOR BUSINESS AFFAIRS) DATE
(MAIL STATION AD24) PERMISSION DENIED
RETURN FORM TO:
NAME: EXT: M/S: FAX:
(Revised 7/07) After approval, Requestor retains Original and
Sends Copies to Food Services and the Responsible University Representative