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  • Petitioner Request

    This form is used for any political related activity on a Coconino Community College campus including voter registration initiatives.
  • Coconino Community College welcomes petitioners to our campuses and asks that you complete the form below to schedule your visit.  Petitioners are welcome to campus during regularly scheduled campus hours.

    Petitioners are subject to all College policies and procedures including Procedure 120-02 Petition Signature Solicitation. Petitioners are asked to avoid being an obstruction to student activities and to avoid disruptions to the College environment.  This procedure also prohibits the distribution of any item except for materials related to the candidate, voter registration, or ballot initiative.  

    A table and chairs are available upon request and will be charged according
    to the Facility Use Fee Schedule (For-profit organizations $50, non-profit organizations no charge).

  • Contact Information

  • Date and Time Information

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  • For petitioner information at the Page Center, contact Jessica Dodson at 928-645-6683 or jessica.dodson@coconino.edu.

  • Insurance Information

  • All non-college parties must submit a certificate of insurance naming the College and including the address of the facility being used.  Commercial general liability insurance should have minimum limits of $1,000,000 per occurrence.  For assistance with a certificate of insurance, please contact your insurance agent. 
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  • Applicant terms, conditions and signature

  • Applicant agrees to hold CCC harmless and will indemnify CCC for damages sustained as a result of injury or property damage for which CCC may be held responsible, as part of this request for use of CCC property.

    Applicant understands that food and beverages may not be offered as part of this request and only items related to the candidate/ballot initiative may be passed out.

    The College reserves the right to cancel any reservation if deemed to be in its best interest to do so. The College will not be responsible for financial loss to a potential user if such cancellation is communicated five (5) calendar days before the scheduled facility use date.  The College will not be responsible for financial loss to a potential user if the facility is made unavailable because of acts of God or any other circumstances beyond its control.

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