Innovation in Outreach Request for School Visit

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School Name
Address
Main Number
Point of Contact Name
Point of Contact Position
Point of Contact Phone Number
Point of Contact Email Address
Type of Event
Level
Date of the Event:
UTEP Virtual Presentations
Start Time
End Time
Grade Level:
Number of students participating per grade level?
Number of Students
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Number of Students:
Virtual Platform to be used:
Arrival Time (The time you will arrive at the UTEP Campus)
Departure Time (The time you will be leaving the UTEP Campus)
Lunch
Number of adults/chaperones (if applicable)?
UTEP at Your School
Setup Time
Start Time
Tear down time
Tabling Event location setting
Classroom Presentation, please select one:
Lunch/Snacks
Parent Presentations
Name of the Event
Number of Parents Participating
About Your School
Grade Level
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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