PRESENTATION and OUTREACH REQUEST FORM
Thank you for your interest in partnering with Verity. We’re always excited to connect with the community through education and prevention initiatives. To request a presentation or tabling event, please complete the form below. We kindly ask that outreach requests be submitted at least two weeks in advance.
Contact Information
Name of Organization/School
Contact Person
Full Name
Title/Role
Phone Number
Please enter a valid phone number.
Email
example@example.com
Event/Organization Details
Select Type of Request
Please Select
Presentation
Tabling Event
Presentation Details
Preferred Date:
-
Month
-
Day
Year
Date
Preferred Time
Hour Minutes
AM
PM
AM/PM Option
Location:
Location details (e.g., address, building, room number, parking instructions, etc.)
Presentation Format:
Please Select
In-Person
Zoom
If in-person: Will a laptop and projector be provided?
Yes
No
If not, what device or setup do you have available for us to present from our laptop: HDMI, AirPlay, etc?
Audience Information:
The audience for this presentation will be (select all that apply):
Community Members
Educators/ School Staff
Parents/Caregivers
Service Providers
Students
Other
If youth:
Age/grade level:
How many attendees are expected?
Language preferred for presentation?
Please Select
English
Spanish
Note: Presentations are offered in either English or Spanish, not both, to ensure we can focus fully on delivering meaningful content within the allotted time.
Do you have a budget for this/these presentations?
Yes, we have a set budget.
Possibly, depending on the proposal or cost.
No, we do not have a budget available.
What would you like your audience to get out of a Verity presentation?
Tabling Outreach Details
Name of the Event
Event Details:
Date of Event
-
Month
-
Day
Year
Date
Time of the Event
Set-up Time
Breakdown Time
Venue Information:
Venue Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Indoors
Outdoors
Will table and chairs be provided?
Yes
No
Audience Information:
What is the occasion/event for tabling?
Who is the expected audience?
(e.g., age group, students, families, Spanish speaking community)
Expected number of attendees?
Additional Information:
Is there anything else we should be aware of, such as special considerations or other important details?
Submit
Should be Empty: