Community Education Presentation Request Form
Organization Name: *
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Unit/Department:
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Event Address: *
Please include the postal code.
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Event Date: *
Notice of at least 10 business days is required.
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Event Time *
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Alternate Date:
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Time
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Alternate Date:
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Audience Size: *
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Audience Type *
(i.e. Teachers, Parents, Doctors, etc.):
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Audience Language: *
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Presentation Duration: *
1 hour each is recommended for Duty to Report, Signs of Abuse and Who We presentations. 30 minutes each is recommended for Home Alone, Babysitting, Positive Discipline for Young Children/Older Children and Positive Parenting for Infants presentations.
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Presentation Type:
Please indicate which Audio Visual Equipment are available: *
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Additional Information:
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