Instructor Name:

Telephone:

Mail Code:

E-mail:

Class Title:

Grade level of Students:

  Freshman   Sophomore   Junior   Senior   Grad

  Other (Please indicate)

Presentation Dates:

1st Choice: 2nd Choice: 3rd Choice:

Time Class Meets:

AM PM

Time Allotted for Presentation:

Location of Class:

Building: Room:

Address (if off campus):

Please indicate the availability of:

DVD

VHS

PowerPoint Projector

Smart Room

Overhead Projector

Number of Students/Members of Group:

Gender:

Please indicate the number of women and men
Women

Men

Topic: