Leadership Takeout Request

Group Information

LEAD Fellows can work with your class, student organization, or group to develop an active learning workshop to meet your needs and desired outcomes. Please complete the form below, include as much detail as you can, and a LEAD Fellow will get in touch with you to schedule a consultation meeting to determine the best approach for your program. 
Preferred Date*
Please allow at minimum three weeks of planning and preparation between your request and the date of your preferred program date.  This allows the LEAD Fellows the appropriate amount of time to properly plan for your program request.  
Alternative Date
Anticipated time of day for your program
Group/Organization Name
Type of Group
Primary Contact*
Who it the best person for a LEAD Fellow to follow up with regarding this request?
Primary Contact Phone Number
Primary Contact Email Address