Student Affairs

Student & Administrative Services Center, Rm. 3009 · (570) 320-5310

Student Enrichment Activity Registration & Scheduling Form

Faculty Contact Information * Optional fields Name
Office Location*

I prefer to be contacted via Method
E-mail address
Phone

Course Information

Course Course
Section
Total number of students

Location Building
Room number

Presentation Information

Date & Time Day of Week
Date
Time

Preferred Presentations List your top three choices of program presentations. We will attempt to schedule your top choice, unless no presenters are available for that topic. Choice #1
Choice #2*
Choice #3*