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Please make the request at least 30 days prior to the event or date desired. Submit a separate form for each request.
* denotes required information.
* Type of Request: Classroom Speaker
* Number of Participants:
* Grade Level:
Special Accommodations Needed:
* School Name/District:
* School Address:
* Contact Person:
* E-Mail Address:
* Phone: Please include area code, and enter only numeric digits. Example 3197522731
Fax: Please include area code, and enter only numeric digits. Example 3197522731
* Preferred Method Of Contact: Phone
In order to add value and relevance to this experience, please complete the following.
How would you like this experience to enhance teaching goals?:
Plans for preparation:
Plans for follow-up:
Career Pathway(s) you would like to target (check all that apply)
Agriculture and Natural Resources
Arts and Communication
Business/Information Management and Marketing
Family and Human Services
Do you have a business or career area/profession in mind with which we can start?
Possible dates and times:
Dates That Will Not Work (Testing, etc.):