UMass Boston

Office of the Vice Chancellor for Student Affairs
phone: 617-287-5800
fax: 617-287-5811
student.affairs@umb.edu

University of Massachusetts Boston
Request to Serve/Sell Alcoholic Beverages
Request must be approved two weeks prior to alcohol being served on campus.

This form must be completed and signed by anyone who wishes to serve or sell alcohol at the University of Massachusetts Boston. It must be completed two weeks prior to the event and sent to the Office of the Vice Chancellor for Student Affairs, Campus Center, 4th floor, telephone 287-5800, fax 287-5811 for approval.

1. Name of Department/Organization:

2. Applicant:

3. Campus Address of Applicant: Email:

4. Campus Phone: Mobile Phone: Home Phone:

5. Name of Event: Date of Event:

6. Type of Event:

7. Location of Event: Time:

8. Number of Attendees:

9. Type of Attendees (i.e. faculty, staff, graduate students, etc):

10. Will there be any students or persons under 21 years of age attending? (Default is No)
Yes No
If answer to #10 is “Yes”, please explain.

11. Type of Alcohol to be served: (Default is Wine) Wine Beer Other
If other, please explain.

12. Person responsible for securing license (Caterer) to serve/sell alcohol (if applicable). Please specify who holds this license:
If outside caterer is used, please fax copy of alcohol license to Division of Student Affairs at 617-287-5811 at least 3 days before catering event is to take place.

13. Name of Person requesting the use of alcohol: Date of Request:

14. Name of responsible Dean/Vice Chancellor: Approval Date:

FOR OFFICE USE ONLY Approved____________Not Approved___________

Name for Division of Student Affairs_________________________ date___________

Name for Department of Public Safety________________________date___________

Approved this request on______________