Explore Your Future at Shell Hebert Career & Technical Academy

SHCTA FACILITY USE – PRE-USE INTAKE & INFORMATION FORM

(Required Prior to Approval & Agreement Drafting) Completion of this form is required before SHCTA will prepare a Facility Use License Agreement. Submission does not guarantee approval.

This field is for validation purposes and should be left unchanged.

ORGANIZATION INFORMATION

Organization Type(Required)
Name(Required)

AUTHORIZED CONTACTS

Authorized Representative Name(Required)
(PRIMARY)
Email(Required)
Mailing Address(Required)

SECONDARY / EMERGENCY CONTACT

Name(Required)
Email(Required)

REQUESTED FACILITY USE DETAILS

Primary Purpose of Use:(Required)
Requested Schedule (Recurring)(Required)

AREAS & ACCESS ACKNOWLEDGMENT

User understands that access is limited to approved areas only.
Areas Requested(Required)
Access Acknowledgment(Required)

EQUIPMENT USE & RESPONSIBILITY

Equipment Access Requested
Equipment Responsibility Acknowledgment(Required)

ADDITIONAL HOURS

If you anticipate needing additional hours or days please let us know.
Additional Hours Acknowledgment(Required)

INSURANCE

Insurance Acknowledgment

PAYMENT ACKNOWLEDGMENT

Payment Terms Acknowledgment(Required)
I understand the payment terms

TERMINATION NOTICE

Termination Acknowledgment
Please let us know what's on your mind. Have a question for us? Ask away.
Consent(Required)
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