Charles Drew University of Medicine And Science - Division of Cancer Research And Training
Community Outreach - ORGANIZATION/AGENCY Request For Support



Organization Name :   Contact Person :


Organization Address :


Contact Phone : Contact E-mail :




 Capacity Building :          


Research or academic support :          


Briefly describe what kind of support/guidance your organization needs :


 PUBLICATIONS (3 publication limit per request)


Title of Publication   Requested for? (clients, event, educational program, etc.) Quantity (25, 50, 100, 100+) Date Needed




Event Title   Event Date & Time
Location   Length of Talk/Presentation
Type(s) of Cancer Covered   Area(s) of Cancer Expertise Needed