PERFORMANCE STUDIES and WSS Students ONLY: MAS Facility Use Agreement Form

NEW MEDIA and MEDIA PRODUCTION STUDENTS USE: MEDIA PRODUCTION STUDENT CONTRACT

This binding contract must be filled out and signed in order to gain access to the Media Art Space, 108 East Franklin St. Facilities

Name*

First Last

UNC ONYEN*

@live.unc.edu

Phone*

PID*

Address*

Street Address Address Line 2 City State ZIP Code

Instructor*

If Other, please enter name

Course Number*

Please enter course#

Section*

TERM*

What is your expected date/semester of graduation?*

I read, understand, and will abide by the Department of Communication documents, policies and contracts. Available for review on medialab.web.unc.edu website:

Media Lab Policies

I have also read, understand and will abide by the Lab Violation Policies: Facility Access Violations include, but are not limited to:

Unauthorized use of facilities for purpose other than that required for a currently enrolled COMM Performance course
Failure to return the space and equipment to an equal or better condition after use.
Failure to properly care for the space and equipment therein.

First-Level Violation: Written warning to the instructor stating violation, potentially resulting in a one week lockout (at the director’s discretion), and possible negative effect on course grade.
Second-Level Violation: Written report to instructor and Director with further access to check out room and lab automatically locked out for two(2) weeks, and possible negative effect on course grade. A 2nd level violation is a significant and/or progressive violation.
Third-Level Violation: Details reported to Dept. Chair, Director and instructor. User banned from further use of the facility, with possible negative effect on course grade. A 3rd level violation is a significant violation. (Example: Theft or malicious destruction of Swain Media Lab equipment, threatening violence)

The facilities/equipment will be used solely and exclusively for Department of Communication Performance Studies class assignments.
I understand that I am personally responsible for all damages or destruction to, or loss of, said equipment whether or not coverage is secured through an insurance carrier. Damage, destruction or loss will be reported to the Department of Communication no later than the beginning of the next workday following knowledge of such damage, destruction or loss. All reimbursement for damage, destruction or loss of such equipment shall be due and payable to the University of North Carolina at Chapel Hill immediately.
Any change in contact information will be reported immediately to the Media Technician. (equipment@unc.edu)
I understand that I must submit a contract for EACH of my classes in MAS to be granted the necessary access to the space.

TERMS OF ACCEPTANCE and SIGNATURE I, the applicant for this UNC-CH Communication Department Facilities and Equipment Usage Agreement, warrant the truthfulness of the information provided in this application. Each party agrees that the electronic signatures, whether digital or encrypted, of the parties included in this Agreement are intended to authenticate this writing and to have the same force and effect as manual signatures. Delivery of a copy of this Agreement or any other document contemplated hereby bearing an original or electronic signature by facsimile transmission (whether directly from one facsimile device to another by means of a dial-up connection or whether mediated by the worldwide web), by electronic mail in portable document format (.pdf) form, or by any other electronic means intended to preserve the original graphic and pictorial appearance of a document, will have the same effect as physical delivery of the paper document bearing an original or electronic signature.
E-Signature*
First Last
Electronic Signature * Please type your First and Last Name
Acceptance Checkbox*
- I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance/Contract..
Date
MM slash DD slash YYYY

PERFORMANCE STUDIES and WSS Students ONLY: MAS Facility Use Agreement Form

COMM Performance Studies Students ONLY