ISCM University Liaison Interest Form

Name:

Email:

I've been working with a University (or Universities) already:

I would like a specific University (or Universities):

Match Me Based on Locaton and Availability

Latitude:

Longitude:

Maximum Number I can take:

Maximum Radius I can travel:

Select km or miles:

If near a border, would you be willing to take a University in a neighboring country?

Background & Credential

Background:

Credential:

A Little Extra

Would you be interested in creating or sharing university-related content? (e.g. presentations, projects, syllabi, etc.)

Would you like to be contacted about travel opportunities to schools in need? (Travel will be non-reimbursable.)

Any other comments