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Request an ACTIVE Workshop
Please note that all portions of the request application must be filled in for the submission to be complete. Each workshop typically runs an hour long.

Please submit a workshop request atleast two weeks in advance, Thank You.

If you are not contacted within a week of your request, please e-mail the ACTIVE Coordinators at active.cccuci@gmail.com

Email address *
Name of Organization
Your answer
Workshop Request *
Contact Name *
Your answer
Email *
Your answer
Phone Number *
Your answer
Workshop Date *
MM
/
DD
/
YYYY
Workshop Time *
Time
:
Alternative Workshop Date *
MM
/
DD
/
YYYY
Alternative Workshop Time *
Time
:
Please describe audience (group size, academic years, etc)
Your answer
Reason for request
Your answer
Location
Your answer
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