Presentation Request Form

Please fill out the following form as completely as possible. The descriptions of the various presentation options are on the presentation request page.

Logistics

Please provide your first and second choice presentation dates and times.

First Choice

Date (format MM/DD/YYYY)

Time (please specify AM or PM)

Second Choice

Date (format MM/DD/YYYY)

Time (please specify AM or PM)

Select what equipment you have available (check all that apply)

Indicate presentation location

Room Number

Building or Location

Select Presentation Option

Audience Information

Class, Group, or Department Name

Estimated Attendance

Expected Type of Attendees (check/fill in all that apply)

How do you plan on advertising for this presentation?
(Please note, the CSU Health Network does not provide advertising)

How did you hear about us?

Other

Contact Information

Coordinator Name

Coordinator class, group,
or department affiliation

E-mail Address

Phone Number (w/ area code)

Additional Information that you would like to share with us about your request