Centre Request Form

Name(Required)

First Last

Email(Required)

Type of request(Required)

Desired Date for Delivery of the Work(Required)

Names and Emails of Anyone to be Included on Communications for this Request

What is Your Request For?(Required)

Other

Who is Your Target Audience?(Required)

Co-op Students

Specific Engineering Stream of Students

Employers

Engineering Students

Clubs/Teams/Societies

Please specify which engineering stream

What Format Would You Prefer? (select one)(Required)

Other

Details of Request(Required)

(including event/workshop name, date/time, and location if applicable)

Prease provide a description of the event or opportunity(Required)

Would You Like a QR Code (for print poster only)?(Required)

Yes

What is the QR Code Link?

Please Upload Any Relevant Files or Imagery

Max. file size: 2 MB.

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