2019 CHINA Town Hall

Local Program Host Venue Application

Thank you for your interest in hosting a CHINA Town Hall program!
The final deadline to submit this form is Friday, October 25. If you would like to request the National Committee's help in identifying a facilitator, please submit this form before Friday, October 11. 

If you have any questions regarding this form, don't hesitate to email us at CTH@ncuscr.org.  
For the information below, we ask that you provide the full name of your institution. Throughout this form, please refrain from using nicknames or acronyms.
Host Organization Information 







Primary Contact Information










Secondary Contact Information (Optional)










Local Program Facilitation




Local Partner Information

Previous Involvement




Audience 








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