Student Centers Film Series- Film and Speaker Request Form

Thank you for requesting a film discussion or panel to be hosted with the Student Centers. If selected, the Student Centers will handle expenses and offer marketing support associated with your proposed film discussion or panel. If you have any questions or concerns, please email Eve Esch, Director of Student Centers, at

First Name
Last Name
University Affiliation
If you are faculty, would you be willing to give extra credit to your students who attend?
Film Title

In the case that we cannot obtain the licensing for your preferred film, please provide an alternative film.

Alternative Film Title
Additional Event Information
Title of Discussion Panel (a discussion or discussion panel is required for proposal approval)
Preferred Date(s) of the discussion or panel
Who is your intended audience?
How many people do you expect to attend?
Will you need the Student Centers to support the marketing of your film discussion or panel?
If yes, please market via:

Please describe any additional requests or information we should know below:

How did you hear about the Student Centers Film Series?