Name
Title
School
Address
Address (cont.)
City
State
Zip
Phone
FAX
E-mail
website

Does your company have a prepared presentation curriculum:

Yes
No

What subject/event/ special holiday would you target:

Which subject area best describes your presentation: (check all that apply)

Animal Care
Art
Banking
Beauty Industry
Business
Crime Prevention
Law Enforcement
Ecology
Economic
Floral Design
Foreign Language
Fire Safety
Gardening
Health/Fitness
Journalism
Judicial System
Math
Medical
Mechanics
Music
Politics
Public Safety
Restaurant Management
Science
Space Travel
Other

Presentation Title:

Grade levels/age groups:

Time needed to make presentation:

Handouts/Videos are encouraged. Will you bring any?

Yes
No

What are they:

What style/method would you use:

Lecture
Hands-on
Interactive
Combination

Would you need audiovisual equipment from the school:

Yes
No

What would you need:

Other information we might need to know?

Would the student be able to visit your place of business:

Yes
No

Would you be willing to fund their field trip expenses:

Yes
No