Southeastern Community College


The Link Request For Speaker/Tour

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    Worksite Tour

* Number of Participants:

* Grade Level:

   Special Accommodations Needed:

* School Name/District:

* School Address:

* Class/Subject:

* 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    Email

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
  Engineering/Industrial Technology
  Family and Human Services
  Health Sciences

Do you have a business or career area/profession in mind with which we can start?
   First Suggestion:

   Second Suggestion:

Possible dates and times:
   First Choice:    Time Range:

   Second Choice:    Time Range:

   Third Choice:    Time Range:

   Dates That Will Not Work (Testing, etc.):


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