Request a Program Form

Please fill in your information
Title:
First Name:
Last Name:
Email:
Phone Number:
Course or Organization:
FAU Course
      Course Prefix:
      Course #:
Student Organization
Other:
Estimated Number of Attendees:
We need to receive your request 3 weeks in advance of your preferred date.
Program Date:
Month: Day: Year:
Building/Room #:
Start Time:
End Time:
Have you contacted a CDC staff member?:   If yes, who? 
Please check any available equipment at your site: Internet Connection
Laptop
LCD Projector
Overhead Projector
Screen
Please select one of the following Programs
Workshop:
Information Sessions:

5 Minute Overview of CDC Services
Information Tables
None