Co-sponsored Workshop Survey for Academic Innovations

Working with your Educational Consultant, please complete the survey that follows.

This information will be used to generate a Memorandum of Agreement and will allow our Workshop Operations Team to plan and execute a high-quality workshop that requires very little effort on your part.

Contact Name:
Contact Title:
Contact Email:
Direct Campus Phone: Fax:
Contact Cell Phone:
Campus Address:
Campus Address 2:
City: State: Zip:
We would like to co-sponsor a:
One-day workshop (8:30 AM to 3:00 PM)
Two-day workshop
Preferred date(s):
Alternate date(s)
Proposed meeting room will hold:
Number of attendees we would like to send:
Our goal for the attendees we send is:
We will need to arrange for lodging for our trainer, and some participants may also need overnight accommodations.
Please recommend three hotels near your campus.
               Contact Person (if applicable)
  Hotel Approx. distance from campus NAME PHONE
We understand that you may not be the person on campus who is responsible for these types of details. If that is the case, please simply provide us with a contact person we can work with to gather complete details. Then the Academic Innovations workshop operations team will step in and make it easy for you to host a dynamic and productive workshop.
Meeting Room Requirements
  • The workshop meeting space should have round or oblong tables
  • Tables should seat 6 people per table
  • Ceiling height should be a minimum of 10 feet.
  • Room should be square or nearly square (not rectangular or elongated).
  • Room should be in an area that will accommodate learning without the distraction of outside noise.
  • Room should be in an area that is not scheduled for renovations or maintenance during the proposed dates.
Is there someone on staff who can provide meeting room specifications?
Name: Title:
Phone: Email:
Meeting Room  
Room Name:
Approximate Room Dimensions: Approximate Square Footage:
Ceiling Height:
Room can accommodate how many:
Oblong tables: Size of table:
Round tables: Size of table:
Is there a diagram of the meeting room available?   Yes    No
Provide URL:
Registration Area
Is there an area just outside the meeting room where participants can check in before the workshop begins? Yes    No
Can you provide 2 tables (8 feet each) in this area? Yes    No
Can the college provide at least one person to check in workshop participants the morning of the event? Yes    No
Is there someone on staff who we can work with regarding catering options?
Phone: Email:
Does your college have a catering department or supplier who handles all events on campus? Yes   No

If no, please recommend an off-site catering company we can contact.

             Contact Person (if applicable)
  Catering company NAME PHONE
On-campus Catering Details

We would like to provide coffee/tea service during check-in and a water station throughout the day. Set up for both should be at the back of the meeting room. (No water on the workshop tables, please.)

Coffee: $      Per: Gallon   Person   Other  
Hot Tea: $      Per: Gallon   Person   Other  
Juice: $      Per: Gallon   Person   Other  
Healthy snack: $      Per: Dozen    Person   Other  
Water station can be provided at the back of the room and refreshed throughout the day? Yes    No
We provide lunch for each participant. We understand that costs will vary, but please provide an average per-person cost for each option below.
Box Lunch Cost: $
Buffet Cost: $      
Serving options -- Lunch can be served:
  In the meeting room
Just outside the meeting room  
Another meeting room area
Are catering menus available?       Yes    No
Provide URL:
Is there someone on staff who we can work with regarding audio visual/equipment needs?
Phone: Email:

Equipment should be set in the room and ready for testing no later than 7:30 AM, and a college technician should be in the room to troubleshoot issues from 7:30 AM until the workshop begins at 8:30 AM.

Please check all options the college can supply.

Clip-on cordless lavalier mic  
LCD projector with wireless remote  
5-foot high stand for LCD  
8-foot screen  
Extension cord for powering LCD  
Flip chart, pad, and markers  
Built in room sound system  

We ship materials (books, handouts, supplies) for each workshop. These boxes will arrive 2 to 4 days prior to the event and will need to be stored and then delivered to the meeting room by 7:00 AM on the morning of the event (or the afternoon/evening before if set-up can be accommodated).

Is there someone on staff who we can work with regarding receipt and storage of the workshop materials?
Phone: Email:
Physical address for shipment of boxes containing workshop books and handouts:
Address 2:
City: State: Zip: