Mayor's Office of Education Scheduling Form
Please fill out the below form with as much detail as possible to speak at your event. Please complete as much of this form as possible to request Otis Hackney or another MOE staff member to attend your event. Forms with more detailed responses will be easier to assess. Please note: submitting a request does not guarantee attendance. Someone will follow up on your request within 3 - 5 business days.
Email address *
Full name: *
Your answer
Contact Phone Number: *
Your answer
Event Name: *
Your answer
Event Description: *
Your answer
Representative's roll: *
MOE Staff member requested: (Staff list can be found here: https://beta.phila.gov/departments/mayors-office-of-education/about/staff/:)
Your answer
Area of Interest: *
Event Date:
MM
/
DD
/
YYYY
Event Start Time:
Time
:
Event End Time:
Time
:
Time frame you require representative's attendance:
Your answer
Attire:
Your answer
Location (include address:)
Your answer
Event type:
Your answer
Expected Attendance:
Your answer
Event Hashtag or Twitter handle:
Your answer
Has press been invited?
Event Agenda:
Your answer
Significance and/or Background of event:
Your answer
Specials Requirements and/or Additional Information:
Your answer
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