Touro University Western Division

Facebook

Home
About Shelley Berkley
About Touro
Contacts
- Meeting Request
- Media
  - Interview request form
Center for Innovative Learning and Teaching (CILT)
- About CILT
- Canvas
- Research Library
- Resources
- Blog

Ideas

This form is for internal use ONLY. If you are a faculty, staff or administrator from Touro University California or Touro University Nevada and have an event you think Shelley should attend, someone she should meet, an organization she should speak to, this form will help with scheduling.

Suggested by:*
Name of TUC or TUN faculty, staff or student providing the suggestion.
Type
- Meeting
- Special Event
- Forum/Conference
- Fundraiser
- Reception
- Graduation
- Tour
- Speech/Featured Speaker
- Media interview
- Other
Location
- Nevada campus
- California Campus
- off-campus, Nevada
- off-campus, California
- Other location
If off-campus, please provide address below.
Date of event
Date Format: MM slash DD slash YYYY

If you have options on dates that you are available, please note the preferred date here and provide additional date options in the text field below.
Start time

: HH

MM
End Time

: HH

MM
Please indicate if meeting includes a meal
Timeframe of required attendance
Please provide the time frame of required attendance. I.E.: if the event is eight hours, but you only need an attendee from 1:00 - 3:00, please note that here.
Requested attendee(s)*
Section Break
Contact Name for meeting*
Who would we contact to schedule a meeting, make reservations, etc?
Daytime phone
(###)###-####
Secondary Phone
(###)###-####
Email
Enter Email Confirm Email
Name of Organization or Company
Name of Meeting/event*
Sponsor(s) of event
Please provide complete address
Street Address City State ZIP Code
Purpose of meeting*
Please provide as many details as possible.
Format of meeting/event
Is there an agenda, program, etc?
Estimated number of people attending
Names of attendees
Column 1 Column 2

click the + box at the right to add up to a total of 20 names
Other speakers/VIP's
Column 1 Column 2

click the + box to the right to add up to a total of 20 names
Touro Goal or Objective
What can Touro achieve by this contact? A partnership, donation, community visibility, etc?
Specific Ask
Detail what Shelley or the executive team member should ask for. What is the need that Touro has that this contact could help with? Donations for? Funding of? Etc
Briefing notes
Other information that may be helpful -- personal connection, audience information, documents that could be provided for background, etc..
Email
This field is for validation purposes and should be left unchanged.

Copyright © 2021 · Touro University Western Division