SCS Outreach Request Form
Please complete the information below to the best of your ability. Our outreach coordinator will get in touch with you about filling your request. If you have questions, contact Brenna Wernersbach at wern0146@umn.edu or 612-626-7313.
Email address *
Type of service *
Brief Description (topic, audience, specific focus, goals, etc. ) *
Your answer
Department or organization name *
Your answer
Requester's name *
Your answer
Requester's email address *
Your answer
Requester's phone number
Your answer
Date of requested program *
MM
/
DD
/
YYYY
Time of requested program *
Time
:
Length of requested program *
Your answer
Location of requested program (building and room number) *
Your answer
Estimated number of students *
Your answer
Additional information
Your answer
A copy of your responses will be emailed to the address you provided.
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