Innovation in Outreach Request for School Visit

Exit Survey
Questions marked with a * are required
100%
School Name
School Type
*If selected 'other' in previous question, please specify below:
Date of the Event:
Type of Event
Total number of students
Number of students participating per grade level?
Number of Students
Headstart
Primary
Pre-K
K
1st
2nd
3rd
4th
5th
6th
7th
8th
Other?
UTEP College and Career Readiness Day/Fair/Classroom Presentations/UTEP College Day
Setup Time
Start Time
End Time
Tabling Event location setting
Classroom Presentation, please select one:
Lunch/Snacks
Field Trips to UTEP

Download Release and Indemnification Forms below:
  1. General Photo Release
  2. Release and Indemnification Agreement (Minor)
  3. Release and Indemnification Agreement (Adults)
Field Trip: Arrival Time at UTEP
Field Trip: Departure Time from UTEP
Please specify program, if applicable. (i.e. Purple Star, AVID, NHS, ENHS, Student Council, etc.)
Are ADA accommodations needed?
Special Tour Requests (enter N/A if none):
Lunch
Number of adults/chaperones
Number of buses
Will buses be waiting or returning to pick up?
UTEP Virtual Presentations
Virtual Platform to be used:
Start Time
End Time
Audio/video test run check-in time
Parent Presentations
Event Name
Start time
End time
Number of Parents Participating
Topic?
Preferred Language
Virtual/In-person?
Point of Contact Name
Position/Title
Phone Number
Email Address
School Phone Number
Questions? Please contact:
Carmen Gonzalez
Director, Innovation in Outreach
Office of AVP for Outreach and Student Access
Division of Student Affairs
Office: 915-747-5473
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