Cosponsorship Request Form If you're interested in having C21 cosponsor your event, fill out the form below. We will review your request and get back to you! If we accept, we can offer a standard cosponsorship amount of $100, plus help in marketing your event. Title of the event:* Name of speaker(s), if applicable: Brief description of the event:*Theme* Well Duty Trust Other Please check all C21 themes that would be covered in this event. Symposia Topic* Loneliness Voting Nourishment Other Please check all potential symposia topics that would be covered in this event. If none of these topics are covered specifically, check "Other".Clarify how this event may fit into one or more themes/symposia topics.*Date:* MM slash DD slash YYYY Note: Please check your date (or proposed date) against the C21 events calendar for potential conflicts.Time: : Hours Minutes AM PM AM/PM Where event is being held: List any other departments/centers you are requesting cosponsorship from: How does this event speak to C21's stated interest clusters?*How much money (if any) are you requesting from C21 for this event? How will the funds be used?*Your name: First Last Your email address:* Your institutional affiliation (department/organization):*