First Name *

Last Name *

Department/Organization *

Email address *

Phone number (xxx-xxx-xxxx) *

What is your role on campus? *

Type of request *

Select topic (If it is an event table request, choose "event table"): *

Date of workshop: *

Time of workshop *

Length of workshop (typically 45-60 minutes): *

Workshop location *

If this request is for a course, please type the course number and name:

Estimated number of attendees (total): *

To help us prepare, list estimated number of students by year in school or indicate if audience is staff/faculty/etc. (Eg. 10 freshman and 15 sophomores or 17 KU staff members): *

Please describe the academic focus (major) of students in your group. If majors, vary, please indicate this: *

What equipment/technology is available in the room in which the workshop will take place *

How do you plan to advertise this workshop to your audience? *

What do you hope students will learn as a result of this workshop? *

Additional information:

Type the characters you see above (no spaces): *