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Community Outreach Support Request Form
Community Outreach Support Request Form
Requestor Information
Organization Name
(Required)
Website
Primary Contact Name
(Required)
First
Last
Title/Role
(Required)
Phone
(Required)
Email
(Required)
Event or Initiative Overview
Event or Initiative Name
(Required)
Brief Description
(Required)
Expected Number of Attendees
(Required)
Has the event occurred previously?
(Required)
Yes
No
Are there community partners or co-hosts involved?
(Required)
Yes
No
If yes, please list:
Event Details
Event Date
(Required)
MM slash DD slash YYYY
If event has more than one date. Please list here:
Event Start Time:
(Required)
Hours
:
Minutes
Event End Time:
(Required)
Hours
:
Minutes
Event Location (Address)
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Is this an indoor or outdoor event?
(Required)
Indoor
Outdoor
Both
Type of Support Requested
(Required)
Tabling / Community Resource Booth
Guest Speaker
Sponsorship Support
Volunteer Assistance
Promotional Support
Mobile Unit (HIV/STD Testing)
(Check all that apply)
Guest Speaker Details: Proposed Speaker Topics
(Complete only if requesting a guest speaker)
Sponsorship Support Details: Sponsorship Amount or Type Requested
Max. file size: 512 MB.
(Complete only if requesting sponsorship support. Include sponsor link packet if applicable)
Volunteer Assistance Details
Number of Volunteers Requested
Briefly Describe Volunteer Duties
Add
Remove
(Complete only if requesting volunteer assistance)
Promotional Support
Social media promotion
Website listing
Email newsletter inclusion
Flyer or digital asset distribution
(Complete only if requesting promotional support)
Mobile Unit (HIV/STD Testing)
Preferred Time Onsite
Estimate Number of Attendees Served
Parking Space Available for Mobile Unit?
Add
Remove
(Complete only if requesting Mobile Unit)
Additional details or special considerations for event or Initiative?
Provide any files that will be necessary for this request:
Max. file size: 512 MB.
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happy thanksgiving.
All resource Center locations
closed thursday & friday,
Nov. 23 &24.
