Alcohol Request Form PLEASE SUBMIT THIS FORM AT LEAST 10 BUSINESS DAYS IN ADVANCE OF YOUR EVENT Alcohol Request Form Requested Campus*UConn StorrsUConn School of BusinessUConn Avery PointUConn HartfordUConn StamfordUConn WaterburyUConn Health School of MedicineUConn Health School of Dental MedicineUConn Health - All other areasOtherUConn Campus LocationPerson Responsible for Payment of Alcohol Services First Last Reason for Requesting a First Right RefusalTitle/Family MemberEmail Please provide your email so we can send you a confirmation message.AddressPhone NumberPlease use this format: (###)###-#### Fax NumberPlease use this format: (###)###-#### Event MonitorEvent DetailsDescription or Purpose of EventEvent Date MM slash DD slash YYYY Location of EventStart Time : Hours Minutes AM PM AM/PM End Time : Hours Minutes AM PM AM/PM Funding Through the UConn Foundation?* Yes No If yes, please add account #*Bar or Served Alcoholic Beverages? Bar Served Cash Bar or Open Bar? Cash Bar Open Bar Time Frame When Alcohol Is Being Offered : Hours Minutes AM PM AM/PM End Time : Hours Minutes AM PM AM/PM Service DetailsType of Food Offered While Alcohol Service is OfferedIs This Event Private or Public? Private Public How Has This Event Been Advertised?Is This a Cash Bar? Yes No Is Alcohol Being Exchanged for Tickets That Are Purchased Separately? Yes No Specify Alcohol Served (Brands of Beer, Wine, Alcohol)Number of Faculty AttendingNumber of Staff AttendingNumber of Students AttendingNumber of Other Guests AttendingWas a Fee Charged? Yes No If a Fee was Charged, for What Purpose?Caterer or Company Providing Bar ServicesName of Caterer or Company*Name of Contact Person*Phone Number*Please use this format: (###)###-#### Fax NumberPlease use this format: (###)###-#### Email*Liquor Permittee (Name)*Liquor Permit Number*Proof that the permit can be used for this location and service described.*Proof of Liability Insurance*Max. file size: 250 MB.Please upload file.Are servers TIPS certified?* YES NO Describe premises where alcohol is being served. The area where alcohol is served must be defined and clearly marked using readily indentifiable boundaries such as fencing or built-in boundaries.*Describe how attendees will be checked prior to being served alcohol.*PhoneThis field is for validation purposes and should be left unchanged.