AB540 & Undocumented Student Center Outreach Form
The Outreach Program’s purpose is to empower undocumented students to pursue higher education by sharing relevant information and resources to help them achieve their higher educational goals. Our intent is solely to provide undocumented students with information that is relevant to their educational pursuits by opening dialogue between the audience and presenters and a safe space during our presentation.

The AB540 and Undocumented Student Center, as a neutral and nonpartisan entity whose aim is to support students in their educational journey has the right to deny presentations in settings that do not adhere to our presentation guidelines.

During our outreach efforts, we typically cover information on the Assembly Bill 540, the California Dream Act, and the resources provided by the AB540 & Undocumented Students Center to prospective students and members of the undocumented community in the Northern California Region.

If you would like information on current political climate impacting the undocumented community, we still encourage you to fill out the form. Shortly after, you will receive an additional questionnaire to determine whether or not we are able to meet your presentation needs.

Thank you!

Name (First, Last)
Your answer
Email
Your answer
Phone of Primary Contact
Your answer
What is your role/affiliation
What is the goal of your outreach event?
Your answer
Have you contacted a staff member already about this event? If so who?
What type of outreach do you need?
What type of event will it be?
In what Language would the presentation be in?
Currently, we are only able to provide English or Spanish
What day will the outreach take place?
Please try to give us notice in advance
MM
/
DD
/
YYYY
Time
:
Where is your event taking place?
Please indicate address
Your answer
Are there parking restrictions?
If parking is not free, choose other and indicate the cost of parking
Who is the audience? List more than one if needed?
ex: Students, staff, faculty, counselors, parents
Your answer
How many people do you expect to attend the event?
Your answer
To the best of your knowledge, will there be people in the audience that can directly benefit from our presence in the outreach event? If yes, can you elaborate?
Your answer
Will there be a projector and cables for a laptop connection available?
Submit
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