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Inquiry Form to Identify a Guest Lecturer from DSHS
Use this form to inquire and request guest lecturer support from the Texas Department of State Health Services (DSHS) for a class or event. All questions can be directed to Dr. Robert Hammarberg (Robert.Hammarberg@uth.tmc.edu).
Provide your contact information below.
First Name
Last Name
UTHealth Houston Email
Office Phone Number (000-000-0000)
Select your primary affiliation with UTHealth Houston School of Public Health.
Student
Faculty
Staff
Select your/the department, office, or center affiliation relevant to this request.
Department of Biostatistics & Data Science
Department of Environmental Sciences & Occupational Safety
Department of Epidemiology
Department of Health Promotion & Behavioral Sciences
Department of Management, Policy & Community Health
Office of Academic Affairs & Students Services
Office of Public Health Practice & Engagement
Library & Graduate Communication Center
Center for Big Data in Health Sciences
Center for Biostatistics Collaboration and Data Services
Center for Community Health Impact
Center for Health Equity
Center for Health Promotion and Prevention Research
Center For Health Services Research
Health Systems Center
Center for Health Care Data
Center for Infectious Diseases
Center for Pediatric Population Health
Coordinating Center for Clinical Trials
Fleming Center for Healthcare Management
Hispanic Health Research Center
Human Genetics Center
Institute for Health Policy
Michael & Susan Dell Center for Healthy Living
Southwest Center for Occupational & Environmental Health
Other
Select the type of speaking engagement/event that best fits your request.
Class lecture
Event panel participant
Event keynote speaker
Training session
Other
Provide the planned date and time of the event.
Date (mm-dd-yyyy) or TBD
Time (CST)
Planned modality for the event.
In person only
Virtual only
Hybrid (with in person and virtual attendees)
Attendance preference for the DSHS guest speaker.
In person
Virtual
No preference
What is the audience for this event? Select all that apply.
Students
Faculty
Staff
Other
What is the anticipated size of the audience for this event?
0-10
10-20
20-30
30-40
40-50
50-60
60-70
70-80
80-90
90-100
100+ (please specify)
What topic(s) would you like the guest lecturer(s) to discuss?
Topic 1
Topic 2
Topic 3
Is there a particular individual, program (e.g., Texas Cancer Registry), and/or area (e.g., infectious disease epidemiology) from DSHS you have in mind? If so, please provide their/its name.
First Name
Last Name
Program or Area
Is there any additional information you would like to provide relevant to your request?
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