Event Request Form

Please feel the form below:

Full name: *

Pronoun:

She, her, hers

He, him, his

They, them, theirs

Other...

Pronoun: Other...

Email:

What kind of support/collaboration are you seeking from the C-Hub team? *

Design of the event/program

Facilitation of an event/program

Suggestions for speakers (internal/external)/ resources

Evaluation/review of an event/program

Please fill out the following fields if you are requesting help with an event:

Name of the event:

Short description:

Timing of the event:

Target audience: Other...

Indicate if an external party is involved in the event:

Yes (indicate the name of the organization):

Indicate if an external party is involved in the event: Yes (indicate the name of the organization):

What code is in the image? *

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