ADAP Outreach

Educational Presentations -- Reservation Form

Please complete the form below to request a presentation. Listing alternative dates and times is recommended in case of scheduling conflicts. You can contact the ADAP office at (405) 974-2215 or adap@uco.edu if you have any questions.

Today's Date:	*
Presentation Topic Requested:	*
Name of Person Making Request:	*
Office Phone:	*
Alternate Contact Person:
Phone for Alternate Person:
Email Address:	*
Confirm Email Address:	*
Department:	*
Class:	*
Presentation Part of Class Assignment?:		Yes No
If Yes, Please Explain:
Number of Students in Class:	*
Presentation Location:	*
Presentation Date:	*
Presentation Time:	*
Alternate Presentation Date #1:
Alternate Presentation Time #1:
Alternate Presentation Date #2:
Alternate Presentation Time #2:
Do you have a computer available for the presentation?:		Yes No
Do you have a projector available for the presentation?:		Yes No
Do you have a designated AV Person?:		Yes No
AV Person Location:
AV Person Phone Number:
Other Pertinent Information:

Enter security code:

University Of Central Oklahoma

Alcohol and Drug Abuse Prevention

Educational Presentations -- Reservation Form

A Division of Student Affairs