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Nursing
Instructor
Culinary

Unassigned Area Form


Pursuant to Pellissippi State Policy 08:03:00, any affiliated entity or affiliated individual or non-affiliated entity or individual wishing to assemble, demonstrate, distribute literature or engage in similar public activity on one of the Pellissippi State campuses must complete an online request form at least five business days in advance of the desired date of the activity. The vice president of Student Affairs or designee will review the requests that relate to or will take place on the Hardin Valley Campus. The appropriate Campus Dean will review the request for the Blount County, Division Street, Magnolia Avenue, or Strawberry Plains campuses. Approval or denial of the request will be in writing and may take the form of an email message. Disapproval of the request to use the unassigned areas will include a statement regarding the basis for the disapproval.

Campus: (required)
Name of Person Making Request: (required)
Street: (required)
City: (required)
State: (required)
Zipcode: (required)
Telephone: (required)
E-mail: (required)
Contact Person On Date of Activity: (required)
Date/Time of Requested Activity: (required)
Please note that activities may not take place before 9:00 a.m. or after 6:00 p.m. Activities may not take place on Saturdays, Sundays or when the College is closed. Activities make not take place during final exam week. Activities may not interfere with scheduled college-sponsored activities.
Date (required):
Time (required):
Number of People Participating: (required)
Children under the age of 18 are not permitted to participate in the activity without being accompanied by an adult.
Activity To Be Conducted (required)
Any literature distributed on campus must comply with all applicable local, state, and federal laws and regulations, as well as rules and policies of Pellissippi State and TBR. No obscene literature or material, as defined by law, shall be distributed on campus.

If this event is being co-sponsored by another group or individual, please list those here:

Please read the following, including the referenced policy, then click on the box below in order to submit your request.
I have read Pellissippi State Policy 08:03:00 Facilities Usage. I agree to abide by this policy, including the indemnification provisions and, if applicable, requirements for a bond. I understand that my request to use the unassigned area will be denied, permission revoked, and/or disciplinary action will occur if I do not adhere to this policy and all college and Tennessee Board of Regents policies relevant to this request.