Thank you in advance for completing this form. The information you provide will allow us to best meet the needs of you and your group.

If you have any questions, please email: program@sfspeakersbureau.org .

* 1. School/Organization name

* 2. Your name

* 3. Your preferred email address and phone number [please include both].

* 4. School/Organization address [please include cross street] & specific room number/s if applicable

* 5. Any additional directional information (special instructions, transit/parking details, etc.)

* 6. Start and end time/s for the presentation/s?

Schools: List the bell schedule class times for each presentation.
For example, a request for presentations for three class periods looks like this:

- Period 2: 9:06 am - 10:06 am
- Period 3: 10:12 am - 11:12 am
- Period 4: 12:03 pm - 1:03 pm

Please also include the class/es subject/s.

* 7. What type of Group or Organization is this?

* 8. Number of students/participants [if multiple groups/classes please list separately]

* 9. For Schools: students’ GRADE LEVEL/S [if multiple groups/classes please list separately]

* 10. For Schools: It is a requirement of SFUSD that a teacher is present in the classroom at all times during the presentation. (No substitute teachers please.)

Please list the name of teacher/s each class.

* 11. We understand and value the importance of community representation in the work we do; thus whenever possible, we match Speakers with similar backgrounds to participants/students.
Please share any information regarding participant/student demographics that will aid us in matching Speakers to your group.

* 12. Please share any other important information about your group:
any issues that may be going on in your school/organization and/or in the work you are doing; any language barriers our Speakers (who are primarily English-speaking) should know about?

* 13. Are there any specific issues you hope to have addressed by our speakers?

* 14. Please provide two to three preferred dates/times when you would like to have Speakers.

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