Special Events Unit

This form is for University funded events only. For VUMC funded events please complete the Medical Center Request for Special Event form.

Event Name
Event Type

Event Type Private Public
Event Start Date Event Start Date / MM / DD YYYY
Event Week Day

Event Week Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Event Address Event Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Building(s)
Lot(s)
Street(s)
Lane Closure

Lane Closure Yes No
Street Closure

Street Closure Yes No
Meters Bagged

Meters Bagged Yes No
Lot Closure

Lot Closure Yes No
Event Start Time Event Start Time : HH MM AM/PM
Event End Time Event End Time : HH MM AM/PM
Total Time (hours)
Expected Attendence
Any Outside Vanderbilt Affiliation

Any Outside Vanderbilt Affiliation Yes No
Dignitaries/VIPs
BOT/Chancellor
Other Special Guests
Entertainment

Entertainment Yes No
Band/Source
Ticketed Event

Ticketed Event Yes No
Alcohol Present

Alcohol Present Yes No
Server
Cash Present

Cash Present Yes No
Event Organization/Department Host
Primary Contact Info
Name Name First Last
Email
Cell Phone Cell Phone - ### - ### ####
Fax Fax - ### - ### ####
Secondary Contact Info
Name Name First Last
Email
Cell Phone Cell Phone - ### - ### ####
Fax Fax - ### - ### ####
Organization Center
Department Name
Phone Phone - ### - ### ####
Complete Billing Address Complete Billing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Financial Responsibility

In order to approve your event, you must provide an authorized signature and center number that can be verified; as well as being on file with the Office of Financial Affairs. A journal entry will be processed for the cost of the event and a copy of the invoice will be sent to the department.
Entity
Net Asset Class
Financial Unit
Program
Activity
Authorized Person’s Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Brief Narrative (Please include how many officers and what their duties will be)
Requests should be submitted three weeks in advance. All event requests are subject to staffing availability.

Police Officers: $62.00 per hour with a four (4) hour minimum per officer and a twenty-four hour cancellation required without charge. VUPD will determine staffing levels and ranks based on the event.

Community Service Officer: $44.00 per hour with a four (4) hour minimum per officer and twenty-four hour cancellation required without charge.

VUPD will determine staffing levels and ranks based on the event. There may also be an additional charge for barricades and/or cones to be set up for the event. Rates for large events that require Command Staff will also be an additional charge. Cost will vary dependent upon the needed amount.

Special Events Unit

Special Events Unit

Event Organization/Department Host

Primary Contact Info

Secondary Contact Info

Organization Center

Financial Responsibility