Requestor Information
First Name:
Last Name:
Campus Position:
Faculty
Staff
Student
Other (Please specify)
Campus Department or Organization:
Phone:
Email:
Presentation Information
Presentation Topic:
Primary Presentation Goals:
What space do you anticipate having for this event (e.g. classroom, library, large hall such as Vandervort, etc)? If you're unable to reserve your first choice, please simply let us know about any changes:
Number of Expected Attendants:
Audience (e.g. first-year students, seniors, faculty, student organization(s) or team(s), community members, etc.):
Please select a time and date. Providing a primary and secondary choice along with making your request in advance (i.e. at least 1-2 weeks or more) makes it more likely that we will be able to accommodate your request.
Primary Date and Time Options
Start Time:
AM
PM
Day:
Date:
Presentation Length (minutes):
Secondary Date and Time Options
Other Information
Any other questions or comments:
Upon submission of this program request form our CCSW staff will be in contact with you to finalize this program request. We look forward to working with you soon.
91 St. Clair Street Geneva, NY 14456
Phone: (315) 781 - 3388 After Hours Emergencies: (315) 781-3333
Hours: Monday - Friday 9 a.m. - 5 p.m.
