Today's date: (ex:xx/xx/xxxx)

Program Information

Name of group to whom this will be presented:

Date and time of presentation
First choice of date:
First choice of time:

Second choice of date:
Second choice of time:

Location for presentation:

Group Information

Number of expected attendance (must have at least 5):

Briefly describe the purpose of the presentation:

Contact Information

Requested length of presentation (30-45 minutes is suggested):

Name of person making request:

Your title/responsibility:

Phone # 

Email: 

Other pertinent information (AV equipment needed, etc.):

You will be contacted about your request as soon as possible. If you do not hear from a SHAPE peer within a week, please contact us at 785.532.6595.

Tips on hosting a successful presentation:
• Need to have at least 5 in attendance.
• Please post flyers for event at least one week in advance.
• Send out email reminder to audience.
• Provide incentives for the audience (snacks, prizes, etc.)
• Meet the presenter at least 5-10 minutes beforehand either in the commons room/lobby or outside the front door.