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



 ORGANIZATION INFORMATION

 

Organization Name :   Contact Person :

 

Organization Address :

 

Contact Phone : Contact E-mail :

 

 CONSULTATION

 

 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 SUPPORT
 

 

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