Outreach Request Form
Thank you for taking the time to provide the following information.  The Cares Team will be in contact with you within 5 days of receiving your request. We will do our best to accommodate all requests. We ask that you submit your request no less than 3 weeks prior to the proposed date.

For questions or concerns, please contact us at conduct@iit.edu 
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Email *
First Name *
Last Name *
Please indicate your IL Tech association *
Required
Please indicate the organization or department you represent *
What is your email address *
What is your proposed topic *
When is your event *
MM
/
DD
/
YYYY
What time is your event *
Time
:
Where will your event be held *
Who do you anticipate being in your audience *
Required
What is your estimated number of attendees *
Please provide some information about what you envision for this program (goals, format, etc.) *
A copy of your responses will be emailed to the address you provided.
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