Academic Success Center

Presentation Request Form

Please complete the form below and submit. After processing your request we will contact you regarding presentation dates and a presenter. Please keep in mind that 2 weeks advanced notice is preferred and 1-week notice is required to meet your needs. Your submission of a request is no guarantee a presenter will be available.

Contact Information

Category*
If other, please indicate the category
Organization/Class Audience*
Contact First Name*
Contact Last Name*
Title
E-mail address*
Phone number*
Mailing address
City, State Zip

Date Preferences (Please list three possible dates)

		Day	Month	Year		Hour	Minutes	AM/PM
First Choice	Date:				Time:
Second Choice	Date:				Time:
Third Choice	Date:				Time:

How long would you like the presentation to be? (number of minutes)*

Note: Done well, we typically need 50 minutes for each topic. Program overviews can be shorter to fit your needs.

Location & Equipment

Address/location where presentation will take place*
What AV equipment is available?
If other please specify

Presentation Information/Content

Please choose the type of information you would like the presenter to focus on: (number of topics and depth covered will depend on length of time provide to us.)

Overview of All Programs/Services	(description of ASC services, including Tutoring, Supplemental Instruction, Disability Resources, Psychology 131, Academic Intervention Program, and Academic Consulting)
Overview of a Specific Program	(greater depth or focus on one of our programs.)
If specific program please indicate which one
Time Management	(strategies for effectively understanding time management, particularly as it relates to studying)
Test Preparation	(strategies to be used thoughout the semester to prepare for test, suggestions for reducing test anxiety, and tips for test day)
Study Skills Overview	(comprehensive discussion of active study strategies such as note-taking, reading, and information application)
Learning Styles	(Based on Kolb's four-stage cycle of learning. Presentation designed for groups of students who work together beyond the presentation.)
Special Request
If special request please indicate the request

Audience Demographic Information

(Check all that apply)

Student:

First Year
Sophomore
Junior
Senior

Faculty/Staff:

Full Time
Part Time
Grad/TA

If relevant, identify the academic discipline/interests of the audience
How many participants do you expect? (Be specific)

Additional Information

What do you hope is gained by the audience with this presentation?
Please enter any additional information you feel is necessary for the presenter to know about the needs of your organization and members.

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Dean of Students Office