To request a TCP speaker, please complete the following information:

Thank you in your interest in TheCollegePlace. Upon submittal of this request, someone will contact you shortly.

1. Choose your location(s):
TCP-Bend
TCP-Manassas
TCP-Richmond

2. Please provide contact information for the group requesting a speaker:

Contact Name:
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Address:
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City/ Town:
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Organization:
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Phone Number:
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Email:
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3. Best Method to Contact Point Person:

Phone:

Email:
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Day of the Week:
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Time of Day:
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4.Proposed date and time of Presentation:

Preferred:
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Alternate:

Alternate:

5. What is the purpose of the Presentation? (1000 words or less)

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6. Please select the following topics:
Please select an item.

Other:
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7. Please describe the audience. Give approximate grade or age groups, total number expected, and whether or not adult teachers will be present if a school setting. Minimum audience size must be 15 participants.

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8. Is any media equipment available at the site (e.g. vcr, projector for a power point presentation, microphone/speakers?)

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9. Please provide any needed information on directions, how early the speaker should arrive before the presentation, where to report upon arrival etc

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