Event Planner Request Form

							                                                   Event Planner Request Form
                                               New York State University Police at Stony Brook University



                   Instructions: Fill out this survey request form and e-mail to campussafety@stonybrook.edu or print and
                                 mail to 175 Dutchess Hall, Stony Brook, NY 11794-5501



                   Name:                                                                    Date:


                   Email:                                                          Phone:


                   Department:


                   Address:                                                        Campus Zip:


                   Date of Event:                  Time:                  PM   Projected Attendance:
                                                                          AM


                   Description of Event:




                                                                    Mail to:     University Police
                                      Print Form
                                                                                 175 Dutchess Hall
                                                                                 Stony Brook, NY 11794
                                     Email Form




UPDF0002 (10/10)                                                                                                  www.stonybrook.edu/police