SUNY's Got Your Back Campus Program Request Form

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Email *

SUNY Campus

Campus Event Contact Information

First Name *

Last Name *

Title *

Department *

Email *

Phone Number *

Event Scheduling: Please identify dates/times that you are interested in hosting SUNY's Got Your Back for the Fall 2022 semester.

Please note that the calendar pictured below utilizes red to indicate unavailable dates .

Potential Event Date # 1: *

YYYY

Potential Event Date # 2: *

YYYY

Potential Event Date # 3: *

YYYY

Potential Event Date # 4:

YYYY

Potential Event Date # 5:

YYYY

SUNY's Got Your Back Bags To Be Assembled

SUNY's Got Your Back project staff will provide all comfort kit items and supplies.

Bags Pledged *

If other, please indicate:

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