LEAP: Presentation Request Form
Organization's Name
Requester's Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Appointment
*
Location of Presentation
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Number of Expected Participants
*
Technology available at venue (Choose all that apply)
*
Computer/Laptop
Projector
Screen
Internet
Type of presentation (Choose all that apply)
*
Overview of our services
General Study Skills Workshop
Peer Services (SI, Tutoring, Peer Mentoring)
Class Presentation
Resource Table
Additional details to accommodate your request:
Submit
Should be Empty: