EmailMe Form - Community Outreach Request Form

Name of Person Completing Form *

First Last

Organization and Event Details

Please provide the following information on your organization and event.

Host Organization *

Organization
Contact Name
Contact Email
Contact Phone Number

Request Type *

Tabling/Resource Fair

Panel/Forum

STAR 101 (15-30 min presentation; Overview of STAR's mission/vision, purpose, history, and programs)

Other

Event Date *

MM / DD / YYYY

Event Location *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Event Time *

Set-up Time
Start Time
End Time

Target Audience *

Description of Audience/Attendees
Estimated Reach (# of attendees)

Specifics on STAR's Participation

Please answer the following questions to help us prepare for your event.

Is a STAR representative required to be present during the event?

Yes

No

If we are unable to provide a representative during the time of the event, would you like us to drop off materials to be displayed during the event?

Yes

No

This event is:

Outdoors

Indoors

If an outdoor event, will a tent be provided by event organizers?

Yes

No

Will a table be provided by the event organizers?

Yes

No

N/A

Will A/V equipment be provided by event organizers?

Yes

No

N/A

The primary purpose of STAR's participation in your event would be to: *

Provide information on STAR's support services to attendees

Provide information on the issue of sexual violence prevention and/or response to attendees

Promote volunteer/community engagement opportunities to attendees

Other

Would you like STAR to add this to our online calendar? *

Yes

No

If yes, please upload event image

Have you already spoken to a STAR staff member about this request? If so, please indicate their name here:

Please provide any additional information about this request.