Faculty and Staff Workshop Request

To request a professional staff member as a speaker, please complete and submit the following form. We kindly ask for at least two weeks notification to ensure staff availability.

Note: All fields are required unless otherwise noted.

* = required field

Your Information

Name *

First

Last

Email Address *

Phone Number (optional)

###

####

Group / Class *

Workshop / Class Presentation

Topic *

Program Description (optional)

Location *

Number of Participants *

Participant Demographics (optional)

Requested Date *

YYYY

Requested Time *

Alternate Date (optional)

YYYY

Alternate Time (optional)

Workshop Length *

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