Corporate Interaction: Product Distribution Request

Who Is Filling Out This Form?
Name
First Last
Role?
Email
If not the student representative or if additional student representatives, name of all student representatives (separate with commas):
If not the student representative or if additional student representatives, name of all student representatives (separate with commas):
Section Break
Brief description of product(s), including estimated value.
Rationale for making product(s) available to students.
Selected (up to 5) peer-reviewed references or other scientific information supporting product efficacy. If such information is unavailable, please explain why.
Product distribution date(s) requested.
Name and contact information of corporate representative.
Name and contact information of student representative, if any.
Affiliated UGA CVM club, if any.
By signing below, I agree to comply with the UGA CVM Corporate Interaction Policy *

Who Is Filling Out This Form?