Interview Request Form

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

Full Name
Health Topic
Description of how information will be used Academic Paper
Tommie Media
KUST Radio Spot
Power Point Presentation
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)

Aquin (List below - Date of Aquin Article)

KUST Radio Spot (List below - Date of program)

Campus Scope (List below - Date of Program)

Student Club or Organization (List below - Club name, Number of students in club)

Deadline for information
If you are wanting to do an interview please submit three dates and times you are available Date/Time Preference 1
Date/Time Preference 2
Date/Time Preference 3
Will the interview be video taped? Yes