DVSCP Education & Outreach Request Form
Name
*
Organization/School/Club Name
*
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Desired Presentation Date/Time
Desired Presentation Length of Time
Desired Topic(s) (if unsure, a member of our team can help)
Approximate Number of Attendees
Attendee Classification (students, medical professionals, salon staff, etc.)
If School, what grade level(s)?
If School, name of class or club affiliation?
If School, number of classes to be seen?
If School, do you need approval from your administration or board and if so, what do you need from us to move that process forward?
Is this a one-time presentation or multi-session?
Location of Presentation
If virtual, what platform will be used (zoom, Microsoft teams, etc.) **Note if you would like to use DVSCP’s platform our zoom account can accommodate 100 participants.**
Are there any accessibility/learnings needs:
Submit
Should be Empty: