Event Sponsorship Request

Use this form for single lectures. To submit proposals for symposia and conferences, please email the following to CCSRE: (1) program description, (2) tentative schedule, (3) estimated budget, (4) anticipated funding sources and amounts.

Please fully complete this form before submitting it.

Your Information
Event Information

Please provide a mailing address, email address and phone number for each visitor.

What courses would be linked to the event? What is the approximate enrollment in these courses? Would any of these courses require attendance at the event?

Briefly explain how this event reflects CCSRE's mission.

Please describe briefly the anticipated impact of this event and how you intend to assess the event’s impact


NOTE: If the presenter/performer is a U.S. citizen, a completed W-9 must be attached to the honorarium voucher. Print form at http://www.irs.gov/pub/irs-pdf/fw9.pdf. If the presenter/performer is NOT a U.S. citizen, please contact the tax manager to determine if a J-1 visa will be necessary and other IRS procedures.


Please list all cosponsors.