WKU CTC Outreach Request Form

Outreach Request Form

Please fill out the form below or send your outreach requests to Betsy Pierce. Please make outreach request 2 weeks prior to the event date needed.

Visit our contact page for Online General Inquiries.

Name of Requestor *

Topic of Outreach *

Preferred Date(s)

Powerpoint Available

Preferred Time

Preference of Staff Member

Your Email *

Phone Number

How Many Estimated in Attendance?

Additional Information

What is ten minus five?

Last Modified 9/19/12