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2018 Youth Outlook Community Education Request
Thank you for your interest in bringing Youth Outlook to your next informational event. Please provide the requested information below, and a staff member will contact you shortly.

Youth Outlook is Illinois' only stand-alone social service agency solely dedicated to supporting LGBTQ+ youth. We work in five counties in the western suburbs, focusing on youth development, parent support, and community education.

Contact Information
Please provide contact information for the point person for this event.
Name of organization: *
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Contact name: *
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Office phone: *
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Cell phone:
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Email address: *
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Mailing address: *
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How did you hear about Youth Outlook? *
If word of mouth, please provide name of the person/organization who referred you.
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Your Event
Name of group/class attending this event: *
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Event location: *
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[1st CHOICE] Date of event: *
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[2nd CHOICE] Date of event: *
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[3rd CHOICE] Date of event:
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Length of presentation: *
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Approximate ADULT audience size: *
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Approximate YOUTH audience size: *
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Audience type: *
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[SCHOOLS] Audience grade level(s):
General Community Education topics:
Choose the topic(s) you would like to address with your particular audience.
Professional Training topics:
Choose the topic(s) you would like to address with your particular audience.
Are you able to offer an honorarium to the speaker(s)? *
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Additional comments:
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