Program Request (Professional Staff)
Please note that we are typically unable to facilitate over the weekends. If possible, please try to select a date during the week, Monday-Friday. Please note that we require 2 weeks notice for presentations/facilitations.
First Name
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Last Name
Your answer
Phone Number
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Email Address
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Are you a:
Required
Are you requesting this program for:
Required
What is the name of the group we are presenting (ex: department, office, student organization or group name, class name, residence hall, etc.)
Your answer
Date requested for program (1st choice)
MM
/
DD
/
YYYY
Time Frame for Program (1st Choice)
Your answer
Date requested for program (2nd choice)
MM
/
DD
/
YYYY
Time Frame for Program (2nd Choice)
Your answer
Estimated Number of Participants
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Room Location
Your answer
What areas are you most interested in having the LEAD Professional Staff address and facilitate on? Please note it's best to choose no more than 1-2 focus areas for a facilitation
Required
Please list any specific needs or accommodations your group may need.
Your answer
Additional notes or comments
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