Independent School District No. 177
Application for Use of Facilities Form
Equal Access Act Meeting

Statement of Policy

It is the policy of this school district to grant equal access to secondary school facilities for students who wish to conduct a meeting for religious, political, or philosophical discussion during noninstructional time, pursuant to the Equal Access Act.

Provision of school facilities does not constitute school district sponsorship of such meeting, and the views expressed therein may or may not reflect those of the school administration, staff, or board of education and are neither approved nor disapproved by them.

Name of student initiating request:_________________________________________________
School: ______________________________________________________________________
Grade:_______________________________________________________________________
Home Room: _________________________________________________________________
Date of Meeting: ______________________________________________________________
Time:_______________________________________________________________________
Estimated number to attend :________
Special Equipment needs:_______________________________________________________
___________________________________________________________________________


(School District Use Only)

Room assigned:______________

Condition of Facilities:__________________________________________________________
____________________________________________________________________________


Staff (if any) assigned to supervise:_________________________________________________
_____________________________________________________________________________


Notes:__________________________________________________________________
________________________________________________________________________
________________________________________________________________________