Community Outreach Form Name* First Last Group/Organization Name* Type of Event* Presentation Tabling Training Survivor Speaker Panel Member Questions for a Paper WRA/C Fundraiser Donation Receivable Please choose from the following for your event typeWhat would you like the presentation to be about:* TESSA Services/ Programs TESSA DV 101 TESSA SA 101 Human Trafficking Elder Abuse Victim Rights and Advocacy Safe Dating Safety Planning Healthy Relationships Bystander Intervention Training Intimate Partner Violence Legal System Hospital and FNE Nurses Bullying Coping Survivor Speaker Mental Health Other (please enter information in text box at end of form) TESSA presentations usually last 30+ minutes depending on what you would like us to discuss or present on.Audience Size*Date* MM slash DD slash YYYY Alternative Dates Please provide alternative dates for your outreach opportunitiesTime* : Hours Minutes AM PM AM/PM Location* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Equipment Provided: Computer with Powerpoint Projector & Screen Speakers Microphone Other How would you like to be contacted for follow-up?* Email Phone Number Anything else we should know?
