Community Conversations Planning Form

College/unit: *

Event details (location, date, time): *

Target audiences (students, faculty, staff): *

Event organizer/point of contact: *

Point of contact email: *

Point of contact phone: *

Moderator name: *

Speakers (please list all with names and titles): *

Speaker request (what unit):

Agenda and topics/questions included in conversation: *

Mental health clinicians attending, if any:

Notetaker name: *

UK Public Relations and Marketing
206E Mathews Building
Lexington, KY 40506-0047
Phone: 859-257-1754
Fax: 859-257-2635
Email: ukpr@uky.edu