Synergy

Impact Division

Use this form to request a student representative from the Impact Division of Synergy. The Division can assists you by: representing the student body on Library Committees, conducting or participating in surveys, taking part in a test groups, giving tours of the library, or being models for brochures.

Please allow 24 hours for processing after your request has been received. Once received the request is received, the Corresponding Secretary will email you on two separate occasions: (1) notification of receipt of request and (2) will announce the name of the Synergy representative. Requests must be submitted at least 14 business days prior to the event.

CONTACT INFORMATION

Your Name:		Email:
Phone Number:		Department:
Name of the Activity or Event:
Date: Example: (mm/dd/yyyy)	Day: (Wednesday)	Time: (3:00pm)
Any Other Details:
Personal Request: (Name of the person you would like to attend)