Presentation Request Form
Today's Date
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Proposed Presentation Date
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Number of Presentations
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Type of Event
Time Allotted Per Presentation
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Organization and Participant Information
Organization/Group requesting presentation(s) *
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Contact Person: *
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Phone Number: *
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Location of Presentation(s):
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Age Range of Participants:
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Approximate Number of Participants:
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Type of Group:
Grade level, group theme, etc.
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If participants are 16 years of age or younger, is a parent/guardian permission form needed?
What role will young people have in planning activities?
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Have participants had an HIV/AIDS education?
If yes, please describe
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Ethnicity:
Language to be used in presentation:
Any special concerns or sensitivities related to HIV/AIDS education?
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Planning Your Session
Equipment available at proposed presentation site:
Choose the Topic of the Presentation
Choose the Specific Workshop(s) for the Presentation based on the chosen Topic:
Please keep in mind that each workshop will last at least 45 minutes.
HIV/AIDS
Sexual Health
Community Resources
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