Letters & Science K-12 Outreach :: Guidebook Request Form

UCSB Academic Outreach: Presentation Request Form

To request a presentation, please complete this registration form. Individual presentations are limited in number; please plan ahead so that you are not disappointed. The Academic Outreach Office will contact the requested faculty member. We will notify you of receipt of your form within two weeks.

For additional information, contact the Outreach Office at 893-7970 (phone) or 893-7780 (fax).

Teacher Name:

School:

School telephone number:

Fax number:

Email Address:

School address:

Subject heading; presentation title; presenter:

Prospective date of presentation:

(Note: A general range, i.e., "anytime in May..." "during the week of..." "any MWF in Sept. during the 11 a.m. hour" is preferable. If your need requires a specific date/time, please specify it along with two alternate date/times.)

Time and length of class period(s):

Grade level:

Number of students in class:

To make the presentation useful to your class, please describe the material you are teaching:

Concepts would you like the presentation to emphasize:

Presentation availability is subject to change.
Please note: All correspondence will be conducted via email.