Orange County Community College 

Central Scheduling Office 

115 South Street 

Middletown, New York 10940 

Phone: (845) 341-4720 Fax: (845) 341-4721 

 

 

 

REQUEST FOR PERMISSION TO SERVE ALCOHOLIC BEVERAGES ON CAMPUS 

 

Requestor Name: 
Today�s Date: 




Group/Organization to be served: 




Event Name: 




Event Purpose/Description: 




Event Date: 
(text) 
tart Time: 
End Time:_______ 




Event Location: Building: 
Room: 


Person(s) directly in charge of 
dispensing alcoholic beverages: 






 

Will non-alcoholic beverages be available for those preferring same? 
(Y/N) 

 

Will non-OCCC affiliated persons be among guests? 
(Y/N) 

If yes, please provide a general description of this group: 
(text) 


 






 

I understand that no alcoholic beverage can be sold at the above event and that no person under 21 
years of age can be supplied with an alcoholic drink. 

 

 
_______________________________________ 
(text) 


 Date (Signature of person making request) 

 

: PLEASE SUBMIT TO

THE OFFICE OF THE PRESIDENT 

ORANGE COUNTY COMMUNITY COLLEGE 

115 SOUTH STREET 

MIDDLETOWN, NY 10940 

 

 

 

SUNY Orange Alcohol Service Request Decision 

 





 ____ Approved 
Disapproved 

 

 

 Comment: 
(text) 




 _______ 
____________________________________ 

 Date 
(text) 
WILLIAM RICHARDS, PRESIDENT 

Do Not Write In Shaded Area Below 

 SUNY Orange 

Alcohol Service Permission Form 

 


(text) 
Event Date: 

The President�s decision will be 
returned on this form. 

Approval is not to be assumed unless 
this form is returned. 

Requestor Name: 
(text) 




Event Date: 
(text) 



(Today�s Date) 
(Requestor Name) 
(Today�s Date) 
(Group/Organization to be served) 
(Group/Organization to be served) 
(Event Purpose/Description) 
(Today�s Date) 
(Start Time) 
(End Time) 
(Building) 
(Room) 
(Person(s) directly in charge of dispensing alcoholic beverages [2]) 
(Will non-alcoholic beverages be available for those preferring same) 
(Will non-OCCC affiliated persons be among guests) 
(If yes, please provide a general description of this group [1]) 
(Today�s Date) 
(Approved) 
(Disapproved) 
(Requestor Name: Event Date:) 
(Today�s Date) 
(Comment [1]) 
(Today�s Date) 
(Print ) Print