BME Outreach
***Please submit requests 2 months or more in advance.
Requests will be filled based on student availability.  There is no guarantee that we can accommodate all requests.   We will respond approximately 1 month before requested dates to notify you if we can accommodate your request.  If you have any questions, please contact Dr. Tracy Jane Puccinelli <tjpuccinelli@bme.wisc.edu>  (BME Outreach Program Director)
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Organization/School *
Address of organization/school *
Name of contact person *
Phone # of contact person *
Email of contact person *
Class/Session/Group Name *
Age/Grade of audience *
Are the people in the audience in High school *
General Content/Mission/Theme of class/session/group *
Number of students (audience) *
Number of underrepresented minorities in class/session/group *
Number of females in class/session/group *
Length of class/session/meeting *
Top 3 Requested Dates and Times of outreach *
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