Interview Request Form

Request for information should be made at least 1 week prior to deadline date.

Full Name:
E-mail:
Health Topic:
Description of how information will be used: Academic Paper KUST Radio Spot Power Point Presentation Tommie Media Video Other (please specify below)
List of Questions of Information needed:
Information needed for: Academic Course (List below-course number, course title, professor, number of students in course) KUST Radio Spot (List below-date of program) Student Club or Organization (List below-club name, number of students in the club) Tommie Media
Deadline for Information:
Date/Time Preference 1
Date/Time Preference 2
Date/Time Preference 3
Will the interview be video taped: Yes No