American Gateways Outreach Request Form
Presentation/Information Session
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Name of requesting agency or organization *
Point of contact's name *
Email address of point of contact *
Format of presentation *
If requesting an in-person presentation, please indicate: 1) Where will the presentation be held?
2) What measures are being taken to recruit participants without putting community members at risk?
For in-person sessions what equipment to we need to bring? (i.e. projector) *
Please briefly describe the intended audience (e.g. students, immigrant families, service providers, law enforcement). *
What is being done to ensure community attendance? (e.g. flyers, social media posts, etc.) *
What is the topic you would like to be covered in the presentation?
 *
How many people do you expect to attend?
 *
What language would you like the presentation in?
 *
Please list at least 3 dates and times your group is available. (Note: presentations generally last 1.5 - 2 hours)
 *
Any other information you'd like us to provide at the presentation? 
Referred by:  *
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