CPL Event Registration Form

Thank you for your interest in this CPL offering.

Please fill out the form to register for the SEAC L@L: Preparing your Educational Scholarship (SEAC) Proposal

SEAC L@L: Preparing your Educational Scholarship (SEAC) Proposal

Date: Tuesday, April 4, 2023

Time: 12:00 - 1:00 pm

Registration Deadline: March 28, 2023

Zoom Only

First Name*

Last Name*

Degree(s):*

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Other Degree (s)

Position Title*

The category that best describes my Position Title is:

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If other please specify:

UNM NetID: Please provide if applicable.*

(This information is available as the last line in your UNM Directory listing.)

School/College Affiliation*

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My department is:*

Please add your department (example: Internal Medicine, Pediatrics, etc.). If you are not affiliated with UNM/HSC please write "None."

Company Name

Business Address

City

State

Zipcode

Country if not USA

Email Address*

(If a UNM/HSC employee, please provide your @Salud or @ UNM address):

If "other", please describe:

Send me a copy of my responses