EYM Guest Speaker Application

Ready to Shape Tomorrow’s Leaders?

Thank you for your interest in serving as a guest speaker for the Young Black Girls in Business program at Enriching Young Minds. Please complete all sections below. Once submitted, our team will review your information and follow up with any questions.

Full Name

Legal First NameLegal Last Name

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Personal Email

Confirmation Emailexample@example.com

Company or School (if retired, please list prior company)

Position or Major (if retired, list 'retired')

Work Email

Confirmation Emailexample@example.com

Which email do you prefer we use?

Headshot Image: Please upload a high-resolution headshot:

Proposed Topic/Title of Talk:

Topic Related Background Short Bio (50–75 words):

Brief Description (2–3 sentences):

Intended Outcomes/Learning Objectives:

Target Audience Age Group(s):

Preferred Session Length:

Why are you interested in speaking to our young entrepreneurs in YBGB?

Relevant Experience or Credentials:?

Presentation Format & Engagement?

Other

How did you hear about Enriching Young Minds?

If a person referred you, please list their name

Permissions & Agreements

By submitting below, I agree to:

Conduct my presentation in a safe, respectful, and age-appropriate manner.
Grant Enriching Young Minds permission to photograph or video record my session and use photos or recordings for promotional purposes.
Hold harmless Enriching Young Minds, its staff, volunteers, and affiliates from any liability arising from my participation.

I hereby certify that all of the information provided by me in this Application (or in any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in these documents may (or will) be cause for the denial of acceptance as a guest speaker, or immediate removal as a guest speaker, regardless of the timing or circumstances of discovery.

YBGB Guest Speaker Application