Please complete the following form at least three weeks prior to your event. 

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* 2. GEAR UP Transition Coordinator 

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* 3. Name of Event:

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* 4. Which service does this event fulfill?

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* 5. Please provide a brief (50 words or less) description of your event:

The description you provide in the above field will be used to provide the Commission staff with a better understanding (and record) of your activity.

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* 6. Date and Time of Event:

Start:
End:

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* 7. Specific location details 

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* 8. If you would like to request the Commission to generate a text to inform GEAR UP students of the upcoming event, please select yes below.

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* 9. If you answered yes to the previous question, please provide a short sample of what you would like the text to convey. Please do not exceed 160 characters.

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* 10. Additional Notes (guest speakers, partnering with other events, etc.):

Questions about this form? Please contact the Coordinator of WV GEAR UP College Transition and First Year Programs at janine.coutu@wvhepc.edu.

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