Ombuds Presentation Request Form

Please fill in all the fields below to request a presentation.  After you submit the form we will send you an email confirming your request, and a representative from our office will contact you shortly thereafter.

Contact Information *Required
First Name:*
Last Name*:
Contact Email*:
Confirm Email*:
Student Organization/College/Department*:
Phone Number*:
Presentation Location Information
Venue Name* (eg. The Reitz Union, College of Education):
Building/Room* (eg. Norman Hall/Rm. 121)
Preferred Date & Time
Presentation Time/Date is Flexible Yes
Date (mm/dd/yyyy):
Time:
Audience Type (eg. Athletes)*:
What do you hope to achieve from this presentation?*
We will provide the following (optional): Laptop
Microphone
Projector
Projector Screen
Audience Size *:
There are errors on your form, please fill in the missing information.