Request a private workshop for ten or more attendees Requestor First Name Requestor Last Name Title Department Requestor Email Requestor Phone [ex. (999) 999-9999 ] Preferred Date and Time Number of Attendees Campus Downtown Phoenix Polytechnic Skysong Tempe West Do you have a campus room reserved Yes No Indicate building and room number Would you like SCE to reserve a room Yes No Is room mediated for a presentation Yes No Are special accommodations needed for any attendee Yes No Please specify type of accommodation needed On a scale of 1-5 (1=low, 5=high) how would you gauge your participants’ existing level of understanding of the topic 1 2 3 4 5 What are the desired or expected outcomes for the attendees Additional Comments Leave this field blank