Speak Out Panel Request Form
Thank you for your interest in the LGBTQA Resource Center's SPEAK OUT panel! Speak OUT is a speaker’s bureau that presents panels of lesbian, gay, bisexual, transgender, queer (LGBTQ) and allied Northeastern students who share their personal stories about being LGBTQ and allies on campus and well beyond, and respond to questions and comments from an audience.

Speak Out seeks to create dialogue amongst students, faculty and staff about LGBTQ issues, engaging in active conversations to cultivate acceptance and understanding of our diverse identities.

To request a panel, please complete the form below so that we may more effectively prepare for your presentation. You may use the same form for multiple presentations of the same format. Please note that request must be received at least four weeks before the event date in order for our panelist(s) to properly prepare.

After receiving your form, we will contact you to confirm your request. Feel free to contact Maria genao-Homs with any questions. We look forward to working with you!

Name
(First and Last)
Your answer
Email Address
Your answer
Contact Telephone Number
Your answer
Your position
(Your role on campus, ex. Faculty, Staff, Club President)
Your answer
Department, Class or Organization
Your answer
Group type
(The context of the group we will be presenting too)
Approximate Group Size
Your answer
How have you or how will you prepare group/class for this panel presentation?
Your answer
Requested length of panel
Requested date of panel?
(Please note that request must be received at least two weeks before the event date in order for our panelist to properly prepare.)
Your answer
Time you would like the panel to start?
Your answer
Location of the panel?
Your answer
What learning outcomes do you hope your audience reaches as a result of the panel?
Your answer
Additional Information or special requests?
Your answer
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