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CC Presentation/Programming Request Form


CC psychologists welcome the opportunity to provide presentations and programming to the UCM community. After you submit this form, we will call or e-mail you to let you know whether we can fill your request. Remember, the more advance notice and flexibility you give us, the more likely we will be able to fill your request.

Type of Presentation/Programming Desired *
Other- (Specific):
Contact Information-Name:*
Phone:
Email:*

                                                                                        CLASS/ORGANIZATION INFORMATION

Name of Class/Organization:*
Location:*
Estimated Attendance:*
Does the room have a media center?*
First Choice, Date & Time-   Month*
Day of the Month:*
Time:*

 

Second Choice, Date & Time-   Month:*
Day of the Month:*
Time:*
Third Choice, Date & Time-   Month:*
Day of Month:*
Time:*

 

Special Instructions: