Workshop Request Form

To mail this form rather than submit it electronically, download this document: Click this Logo to download the .doc version of this document  and mail/fax to:

Career Development Center GC - 306
Buffalo State College
1300 Elmwood Avenue
Buffalo, NY 14222
Fax: (716) 878-3152

Requests will be confirmed/denied within one week of the date of the request.  
At least three weeks notice is recommended.

*Required
Name:  First: Last:
Title:
Department/ Club/Organization:
Office Phone Number:
Dept. Phone: 
(or home phone if appropriate)
Campus Address:
(or home address if appropriate)
E-mail:
Topics Requested:

(Hold ctrl to select multiple)

Other Topics:

Class/Organization:
Group Characteristics: 

(Hold ctrl to select multiple)

Other Characteristics: (e.g. major(s))

Workshop Location:
Building:
Room:
Approx. number of students:
Length of time allotted:
Address if off-campus:
List three dates and times in order of preference:
1st and 2nd choices required.
3rd choice is highly encouraged.
  Day Date Time
*1st Choice    
*2nd Choice    
3rd Choice    
Comments/Additional Notes:

     

Updated: 01/22/2007