Adopted:  04/15/1991

Revised:  02/19/2007                                                                                       742.1 -Exhibit

School District of Prairie Farm

Facilities Use and Property Loan Agreement

Use of School Facilities Application Form

Name of Organization:_____________________________________________________

Designated Representative:_______________________________Phone # ____________

Check Function: _________Private;__________School;________Community Education

Date this form is submitted for approval:_______________________________________

We wish to use:___________________________________________________________

For what purpose:_________________________________________________________

Alternate location if your first choice is in use:__________________________________

Date(s) you want to use the facility:___________________________________________

Time of use:_____________________________________________________________

Special request for equipment (chairs, tables, video, overhead projector, screens, etc.):

_______________________________________________________________________

User fee:_____________________________

Approved by:_________________________ Date:_______________________________

Denied by:___________________________ Date:_______________________________

Reason for denial:_________________________________________________________

Routing to:        Other building Administrator____________________

                        Community Ed. Coordinator_____________________

                        Administrative Secretary________________________

                        Posted on building usage calendar_________________

*After routing and posting on master calendar, return a copy of the application form to designated representative.