Visiting Lecture Request Form

The program is free and designed to spark interest in the biomedical sciences and to further awareness of opportunities at SUNY Upstate. Please refer to our brochure for more information. To schedule one of our lecturers to come to your campus, please complete the following form. All fields are required.

*=required

Requester's Information

*First Name :

*Last Name :

*Title :

*Department :

*Campus :

*Campus Street Address :

*City :

*State :

*Zip Code :

*Phone (000-000-0000):

*E-mail :

Date/Time Preference

Please indicate date and time preferred for the visiting lecture (Note: this will require a two-hour block)

*Date (mm/dd/yyyy):

*Time :

Is there an alternate date and time available?

*Date (mm/dd/yyyy):

*Time :

Upstate Visiting Lecturers

Due to travel and faculty availability please select three lecturers. We will make every attempt to match you with your first lecturer choice. To learn more about our faculty and their research projects, please visit our Website.

1st Choice:

2nd Choice:

3rd Choice:

Comments

This question is to prevent automated spam submissions.
Math question: * 2 + 10 =
Solve this simple math problem and select the answer.
E.g. for 1 + 3, select 4.