Diversity Outreach Collaboration

Please complete this form to request a presentation about the Diversity Outreach Collaboration & graduate school opportunities at UCSD.

YOUR INFORMATION

First Name:

Last Name:

Institution Name:

Phone:

Email:

ABOUT YOUR STUDENTS

Please give us the name of the prep-program or grant with which you are affiliated. (Prep-program examples include: MCNAIR scholars, MARC scholars, etc.)

REQUESTED DATES OF THE PRESENTATION

Please note, all requested presentation dates must be no sooner than 3 weeks from today�s date and in MM/DD/YY format

First Choice:

Second Choice:

Third Choice:

Office of Graduate Studies
9500 Gilman Drive
La Jolla, Ca 92093-0003

Phone: (858) 534-3678
Fax: (858) 534-4304