Www.paleosoc.org
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PSDL Request Form
Please fill out the information below and mail it to:
M. Gabriela Mangano (PSDL Coordinator)
gabriela.mangano@usask.ca
Also cc Claudia C. Johnson
Secretary Paleontological Society
claudia@indiana.edu
VERY IMPORTANT- Feel free to contact the selected Distinguished Lecturer to discuss the details of the visit, potential dates, etc. BEFORE filling in this form.
1- Requested Distinguished Lecturer/Educator:
Name:
Email:
1a. Why you would like this particular PSDL visit your institution?- Please, highlight the benefits this visit may provide
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2- Host Institution:
Name of Institution:
Name of person responsible: ________________________________________________
Position: ________________________________________________________________
Email:
2a. Was your institution visited by a PSDL lecturer in the last three years?- If yes, please describe the visit.
________________________________________________________________________________________________________________________________________________________________________________________________________________________
Total Amount Requested from Paleo Soc. _________________
3- Plan for lecturer’s visit- Please, provide a brief description of the plan of the visit (e.g. number of talks and intended audience, other activities with students, etc.)
3a. Potential date(s) of the visit. _________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
* Reimbursements must be submitted within 30 days after the PSDL visit
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