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Outreach Request Form

Fields marked with an asterisk (*) are required.

*Name:
*Email:
*Phone number:
Type of Outreach:
Title of Presentation:
Topics to be covered /
Emphasis of presentation
(please select all that apply):
Who we are / What we do
Differences from High School to College
Disability as a minority status
Being an advocate
Universal Design: creating accessible space
Accommodating different learning styles
Case Studies
ATEC Services
ADA / Employment Accommodations
Other
If the topic is other,
please describe:
Duration of time:
Who will the audience be:
If the audience is students,
what is the major of the majority:
If the audience is other,
please describe:
Name of course / group:
Meeting place:
Preferred date / time:
Alternate date / time:
Expected Attendance:
Will audience members require accommodations? If so, please describe in Comments  section.
Comments: