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Involvement Policy Exemption Request

Organization Name:

Event Contact

Full Name:

Phone Number:

E-mail Address:

Faculty/Staff Adviser

Full Name:

Phone Number:

E-mail Address:

Nature of Event:

Purpose of Event:

Event Date:

Will this event take place on more than one day? If yes, please list all of the dates below:

Event Duration
Only one time slot may be selected. A separate form will need to be filled out for each different time slot, if applicable.
Start Time:

End Time:

Why does this event deserve an exemption?

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