Registration Form

Mental Health on College Campuses FIU-UT1C Colloquium

Tuesday October 22, 2019 | 9:00 AM - 5:00 PM | FIU Modesto Maidique Campus

Wednesday, October 23, 2019 | 9:00 - 12:30 | FIU Miami Beach Urban Studios

Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Social media handles (optional)
Presenter status

Presenter status Presenting paper or panel speaker Presenting poster Participant
Department or Program
University or Organization
Type of participant

Type of participant Student Faculty/researcher Program staff or administrator Other Other
Please indicate your proficiency in each of these languages:
English
French
Spanish
Attending (Check all that apply)

Attending (Check all that apply) Morning paper session (Tue Oct 22, 9-11 am) Panel discussion (Tue Oct 22, 11 am-12:30 pm) Afternoon paper session (Tue Oct 22, 2-3:30 pm) Poster session (Tue Oct 22, 3:30-5 pm) Research rountables (Wed, 9:30 am - 12 pm - new location, Miami Beach)
Do you require special accommodations?

Do you require special accommodations? Yes No

If yes, please e-mail mevillar@fiu.edu or call 305-348-7644.