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Outreach Request Form

To request a speaker or exhibitor for outreach purposes, please complete this form at least three (3) weeks prior to the event to ensure staff availability. You will be contacted within five (5) business days by our outreach coordinator, Jamila Brown.

(fields marked with * are required)

Section I: Event Logistics

Event Name *
Event Date *
Start time *
End time *
Sponsor Organization *
Contact First Name *
Contact Last Name *
Contact Title *
Org/Dept

Event Location

Street Address *
Building/Room #
City *
State *
Zip *
Additional Information

Link to additional information on the events location (map, directions, etc.)

Section II: Event Profile

Type of Event *
Language *
Anticipated # of Attendees *

Audience *(Select as many as apply)

Highschool:( )

Presentation Type

Type of Presentation *

Will a laptop or projector be needed for the presentation?

If a laptop or projector will be needed, my organization/department will provide a:

Presentation Topics *(Select as many as apply)

Material Requested *(Select as many as apply)