CAPS Outreach Request Form
Please fill out the following request form at least 2 weeks prior to your program or event
* Required
Name (first & last)
*
Your answer
Phone number
*
Your answer
Email
*
Your answer
Date/time/location of your request (please keep in mind that we kindly request a 2 week notice)
*
Your answer
What type of outreach are you requesting?
*
Workshop/Training
Tabling
Tour of the Center
Other:
Please describe your request
*
Your answer
Are you affiliated with UCSB?
*
Yes (faculty/staff)
Yes (student)
No
If yes, what is your department or student org?
Your answer
Who is the audience for this request?
*
Undergraduate Students
Graduate Students
Staff
Faculty
Other:
What is your expected attendance?
*
Your answer
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