UVM Focus the Nation Teach-In Form

Sign up to participate in the Teach-In events by filling out the fields below.  While we will eventually need to
solidify the title of your teach-in, and when & where it will take place, it's alright if you don't have those details
yet.  If you could pick a temporary title to help us keep track of things we'd greatly appreciate it.  Just keep
us posted as you go.  Thanks!

* Required Fields

Your Name: *   
Your Department: *   
Your E-Mail Address: *   
School Affiliation: *
           Graduate Student   Faculty   Staff   Other  

Title of your event (Can be changed later): *  
Date & Time of event (If unknown, please write TBA):  
Where will event take place (If unknown, please write TBA):  

Course in which your event will be presented:
Can guests attend the lecture: Yes No
          If yes, please indicate an upper limit:

Can we provide you with additional help in preparing for your event?   Yes No
          If yes, how so?  

Please provide a short description of your event:
         
Questions or Comments:
          


    

 Thank you for your participation in UVM Focus the Nation!