2020-2021 National Consultant Team Request Form

Thank you for expressing an interest in hosting a National Consultant team member at your meeting. In order for us to process your request, please complete this survey and we will get back to you shortly.

Please contact Ashley Nelson, Professional Development Manager, with any questions at adviser@fcclainc.org.

Question Title

* 1. Requested By:

Name: *

Chapter/Region/State: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Email Address: *

Phone Number: *

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* 2. Meeting & Location Information:

Meeting Name:

Meeting Location:

Location Address, City, Zip:

Meeting Dates:

Meeting Theme or Focus:

Anticipated Attendance:

Question Title

* 3. Which member(s) of the National Consultant Team are you requesting?

Rene Ketchum, Washington

Alaina Tharp, Ohio

Sherry Vogel, Iowa

No Preference (National FCCLA will work to determine best person to fit the request based on the team members availability)

Additional Requests/Information

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* 4. Requested Date of Arrival:

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* 5. Requested Arrival Time:

Morning

Afternoon

Evening

No Preference

Additional Arrival Information:

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* 6. Requested Date of Departure:

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* 7. Requested Departure Time:

Morning

Afternoon

Evening

No Preference

Additional Departure Information:

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* 8. Presentation Request 1

Date/Time:

Presentation Type (keynote, workshop, greetings, etc.):

Topic:

Audience (student, adviser, etc.):

Audience Size:

Additional Information:

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* 9. Presentation Request 2

Date/Time:

Presentation Type (keynote, workshop, greetings, etc.):

Topic:

Audience (student, adviser, etc.):

Audience Size:

Additional Information:

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* 10. Presentation Request 3

Date/Time:

Presentation Type (keynote, workshop, greetings, etc.):

Topic:

Audience (student, adviser, etc.):

Audience Size:

Additional Information:

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* 11. Presentation Request 4

Date/Time:

Presentation Type (keynote, workshop, greetings, etc.):

Topic:

Audience (student, adviser, etc.):

Audience Size:

Additional Information:

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* 12. Presentation Request 5

Date/Time:

Presentation Type (keynote, workshop, greetings, etc.):

Topic:

Audience (student, adviser, etc.):

Audience Size:

Additional Information:

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* 13. Below is a list of expenses that you agree to cover.

Transportation To/From Meeting

Lodging

Meals

A/V Equipment

Supplies/Printing

$250 stipend paid directly to NCT member

I agree

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* 14. For virtual requests, a stipend of $50 per presentation (keynote, workshop, etc.) will be paid directly to NCT member.

I agree

Not applicable

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* 15. Once this request is submitted, FCCLA will coordinate with the requested NCT member to ensure availability and willingness to participate. Following this confirmation, FCCLA will send a signed Memorandum of Understanding for your review and signature.

By checking this box, the requester verifies that all information above is accurate to the best of their knowledge and they understand National FCCLA must have a signed MOU prior to making arrangements for the NCT member to participate in the meeting.

I agree

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* 1. Requested By:

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* 2. Meeting & Location Information:

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* 3. Which member(s) of the National Consultant Team are you requesting?

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* 4. Requested Date of Arrival:

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* 5. Requested Arrival Time:

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* 6. Requested Date of Departure:

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* 7. Requested Departure Time:

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* 8. Presentation Request 1

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* 9. Presentation Request 2

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* 10. Presentation Request 3

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* 11. Presentation Request 4

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* 12. Presentation Request 5

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* 13. Below is a list of expenses that you agree to cover. Transportation To/From Meeting Lodging Meals A/V Equipment Supplies/Printing $250 stipend paid directly to NCT member

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* 14. For virtual requests, a stipend of $50 per presentation (keynote, workshop, etc.) will be paid directly to NCT member.

Question Title

* 13. Below is a list of expenses that you agree to cover.

Transportation To/From Meeting

Lodging

Meals

A/V Equipment

Supplies/Printing

$250 stipend paid directly to NCT member