COURI Class Visit Request Form

First Name *

Last Name *

Email Address *

Audience Information

Is this for an undergraduate course? *

Yes

What is the CRN of the course? *

Members of the audience *

Students

Faculty

Staff

Other (fill in) Other (fill in)

Approximate size of audience (Total) *

Location

	Building	Room
Location	Building	Room

Date * +

Time (minimum presentation time is 20min; we will arrive 5-10 min before)

	Start	End
Presentation	Start	End