Student Organizations
Student to Student

Request a Program

Instructions: Talks for the 2012-2013 school year can only be presented between 12:30 and 5:30 p.m. to accommodate student class schedules. The last talk for the 2012-2013 academic year will be on May 17. Please allow at least two weeks notice after submitting your request. Thank you.

Today's Date:

School:

Address:

City:

Zip:

Contact:

Title:

Day Phone:

Eve. Phone:

E-mail:

Talk #1

Which talk would you like presented?

Grade Level: Number of Students:

Preferred Date: Time:

Special consideratiions, if any:

Talk #2

Which talk would you like presented?

Grade Level: Number of Students:

Preferred Date: Time:

Special consideratiions, if any:

Talk #3

Which talk would you like presented?

Grade Level: Number of Students:

Preferred Date: Time:

Special consideratiions, if any:

Additional talks: (Please provide the same information as above or submit an additional form.)

Comments:

Thank you!

Last updated: March 20, 2013