Online Faculty/Staff ADL Presentation Request Form

NOTE: Requests must be received 2 weeks prior to date of presentation

Requestor’s Full Name


Department


Email Address


Phone Number


Type of Presentation (Full ADL Trainer Program or segment?)
*Note – Dr. Rodrick Moore, Director of OMSA, will contact you regarding details of your presentation.


Reason for Presentation


Requested Date of Presentation


Time and Length of Presentation (ex. Nov. 3, 3-4pm)


Location of Presentation (You provide the location)

What technology is available in this location?


Special Requests/Additional Comments