Outreach Request Form
Your Name:
Your answer
Email Address:
Your answer
Phone Number:
Your answer
Name of Event:
Your answer
Address of Event (street, city, state and zip code):
Your answer
Organization/School/Department of UMCP Requesting Outreach (please do not use abbreviations):
Your answer
Date of Event (mm/dd/yyyy):
Your answer
Start Time (e.g. 9:00am):
Your answer
End Time (e.g. 1:30pm):
Your answer
Type of Event (select one)
Presentation Options (select one)
Anticipated Number of Attendees (select one)
Audience (select as many as apply):
Presentations are in PowerPoint format and a computer/projector combo will be required on site. Please check each item to confirm availability:
Within 2 - 3 business days, an Outreach staff member will contact you to discuss availability. Please plan a minimum of 3 weeks lead time to allow support as many requests as possible. Depending upon your event, exceptions to this timeframe will be considered.
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