Request a Workshop
Please note that all portions of the request application must be filled in for the submission to be complete.
If you are not contacted within a week of your request, please e-mail the REACH Coordinator Vania Agama Ramirez, vagamara@uci.edu
Name of Organization: *
Your answer
Workshop being Requested: *
Required
Contact Name: *
Your answer
Email: *
Your answer
Phone Number: *
Your answer
Workshop Date: *
MM
/
DD
/
YYYY
Time
:
Alternative Workshop Date (If desired date is not available)
MM
/
DD
/
YYYY
Time
:
Purpose of Workshop:
Your answer
Number of Participants: *
Your answer
Location: *
Your answer
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