Contact Form

First and foremost, we thank you for taking time from your busy end of the year schedule to answer a few important questions and provide your opinions regarding the quality of our services. Your participation in this survey will greatly enhance the technology and instructional development services offered to both current and future COEHS students.

In addition to providing better quality assistance through our current staffing resources, we are beginning a new initiative (Interactive Innovations) in which we would like to link technology user's throughout the University community.

Would you be interested in providing any type of face-to-face or online volunteer service to share your technology expertise or field expertise (technology related or instructional development related) with others?

If so, please fill out the contact information below so that we may contact you and invite you to participate in this initiative!

Please note, the survey you just filled out is completely anonymous. The contact form below is separate, and your participation is completely voluntary.

If you do not want to complete the contact form, close your browser now.

Thanks for your participation!

Your Name*

First NameLast Name

Your E-mail Address*

Phone Number

Area CodePhone Number

Your Department/Company/Organization*

I am a:*

Please briefly explain how you would like to be involved with our new initiative (what can you share in terms of technology or instructional development knowledge): *

If you are a teacher, manager, business owner, student or community organization leader, would you be interested in bringing your class, staff, or organization to our facilities for a training event? If so, please describe your current needs and interests.

We are taking this opportunity to follow through on our theme of "We are Community" by providing our resources as a free service. With that said, we will be hosting one fundraiser per year to off set costs such as specific materials for events, transportation to events (for area schools), and event supplies. What types of fundraising support would you most likely participate in? (Check all that apply.)

I am not interested at this timeYearly monetary donationSmall monetary donation at events I attendMaterial or supply based donationFood or drink donationAttendance at yearly fundraiser $15 or < per ticket (Music Trivia Night)Attendance at a yearly fundraiser $15 or < per ticket (Movie Trivia Night)Donate my service or knowledge as a presenter or event participantOther

Preferred Contact?*

E-mailPhone