Scheduling Form
We will do our best to schedule based on your needs. Please contact uchoose@stcloudstate.edu if you have any questions.
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First Name:
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Last Name:
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Position on Campus:
Faculty
Staff
Student
Community Member
Other
If you are scheduling for a class or organization please enter the name or class:
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Best Phone To Reach You:
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Email address:
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Date:
First Desired Date & Time:
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Time:
Second Desired Date & Time:
Date:
Time:
Third Desired Date & Time:
Date:
Time:
Presentation Details
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How many people do you expect:
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How long would you like us to present for:
(the minimum time is 50 minutes)
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What type of program would you like presented (please select more than one option if you would like multiple topics to be covered):
Alcohol Use/Abuse
Sexual Consent
Academic Performance
Athletic Performance
Alcohol's Impact on Your Student Organization
Marijuana/Other Drugs
Other Topic:
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Where would you like the presentation (please be very specific if off campus):
Please describe the audience (e.g., gender, year in school, group/ class description):
Are there any special concerns or issues that we should know about your request or audience that might help us customize our program to your needs? Please describe:
How did you hear about our programming?
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Sometimes we like to video tape our presentations for training purposes. The video tapes the presenter and not the audience. Would you mind us video taping the presentation for purposes of training?
Yes
No
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Indicates Response Required