Contact Person/Title:

Date Requested:

Department:

Address Building/Rm.:

Email:

Telephone(Ext.):

Date & Time of Presentation:

Number of Participants:

Presentation Objectives

1.  Objective/Focus of Presentation

2.  Length of Presentation

1 hr 2 hr 3 hr Half Day Full Day

3   Reason for Training Request

Resource Allocation

1.  Smart Room will be provided

Yes No

2.  DVD/Video Player will be provided

Yes No

3.  Poster Board or Easel Pad will be provided

Yes No

4. Special Accommodation Needed

Yes No

Details

 Certificate Requested

Yes No

Additional Comments