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Speaking Engagement and Presentation Request Form

David Geffen School of Medicine at UCLA
Outreach and Pathway Programs Office

We welcome requests for a member of our team to speak at events relating to medical school admissions, pre-health pathway programs, and to learn more about the David Geffen School of Medicine at UCLA!

Please keep in mind that due to the volume of requests, schedules are extremely limited, and we encourage to request at least 6 weeks prior to your event.

Submitting this form does not guarantee approval. We will contact you within a week of submission regarding an update wether we can accommodate the request or not.

Contact Information

Please provide the following information for the best person to contact regarding this request

Name of School/Organization/Group/Company

Name and Title

Email Address

Phone

Event or Organizers website if available

Event Information:

Enter a date:

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Event Start Time (hh:mm timezone)

Event End Time (hh:mm timezone)

Is this date flexible?

Yes
No

Alternative Dates (mm/dd/yyyy) and time (hh:mm timezone)

Option 2

Option 3

Event Format

In-Person
Virtual (Link provided by requestor)
Open to In-Person or Virtual

Is registration required for this event?

Yes
No

Is there a registration fee?

Yes
No

Registration fee:

Address of In-Person event (Street Address, City, State and Venue if applicable)

Is tech set-up for PowerPoint available if needed?

Yes
No

Choose what best describes our participation in this event

Please give an overview of the event (e.g., conference, school org meeting, etc) and include any helpful details

Estimated number of attendees

Please describe the attendees for this event

Topic(s) that you would like for us to discuss

Pre-Med & Pre-Health Opportunities at DGSOM
General Medical School Guidance
DGSOM Admissions Process
Medical Tracks at DGSOM (Traditional, Prime-LA, MSTP)
Other (specify)

Will this event be recorded?

Yes
No

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Speaking Engagement and Presentation Request Form

David Geffen School of Medicine at UCLA Outreach and Pathway Programs Office

David Geffen School of Medicine at UCLA
Outreach and Pathway Programs Office

Previous Month (March 2025) April 2025 Next Month (May 2025)
Su	Mo	Tu	We	Th	Fr	Sa
30	31	1	2	3	4	5
6	7	8	9	10	11	12
13	14	15	16	17	18	19
20	21	22	23	24	25	26
27	28	29	30	1	2	3
4	5	6	7	8	9	10