TechOWL Community Space Interest Form
Full Name
*
First Name
Last Name
Location
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
Organization
How did you hear about us?
*
Please Select
TechOWL Staff
Social Media
Friend
Service Provider
Community Program
Institute on Disabilities at Temple University
Other
Please Specify
*
How would you like to use the TechOWL Community Space
*
To hold a community event
To host a meeting
Other
Please provide further detail about how you would like to use the TechOWL Community Space:
*
Provide you preferred date to utilize TechOWL's Community Space:
First choice:
*
-
Month
-
Day
Year
Date
Second choice:
-
Month
-
Day
Year
Date
Third choice:
-
Month
-
Day
Year
Date
Timeframe
Number of people expected
*
What accessibility/accommodations will you provide at this event?
Masks required
ASL interpreter
CART captioner
Sighted guides
Other
Additional information:
Submit
Should be Empty: