Presentation Request

A 14-day advanced notice is preferred to secure a speaker. The earlier your request is submitted, the more likely DARCC will be able to accommodate it. Unfortunately, we cannot guarantee a specific speaker.

To schedule more than one session or training, please complete one form for each event.
Alternatively, you may print the request form and submit via email at Should you have any additional questions, please contact or call 214-712-4914.

Agency Information:

Date of Submission:



Phone Number:

E-mail Address

Presentation Information:

Presentation Topic (check all that apply)
Sexual Assault AwarenessRoots of Sexual ViolenceSexual HarassmentUnderstanding TraumaPTSD/Rape Trauma SyndromeHistory and Prevention of Sexual ViolenceBystander InterventionCrisis Intervention (youth & adults)Standing up to InjusticeSexual Violence: Defining the Problem and Moving ForwardBreaking the Box: Gender Norms and Sexual ViolenceCustomized prevention programs for Middle School and/or High School YouthOther

If checked other, please use space below to provide further information.

Preferred language of speakerEnglishSpanish

Target Audience of Speaker AdvocatesGeneral Community MembersMedical Care ProvidersClinical/Mental Health ProvidersCJ/Law EnforcementEducatorsGrade School StudentsCollege StudentsFaith-Based Organizations or ChurchOther

If you selected 'Other', please use this space to provide further information:

Estimated Audience Size

First Choice Date and Time

Second Choice Date and Time

Name of Event and/or reason for presentation, if any.

Will table materials be required? (display board, brochures, table cloth, etc.)

If yes, what are the tabling hours requested?

Equipment/Materials available for use at presentation site (check all that apply)
Laptop (Mac/PC)DVD PlayerMicrophoneInternet AccessLCD ProjectorPresentation Paper/EaselTelevisionProjection ScreenDry Erase BoardPA Systems/SpeakersChalkboard

Name of contact person on day of event:

Contact Cell Phone Number:

Building Name and/or Classroom Number:

Street Address, City, Zip Code

Special Parking and/or Security Instructions

Any additional notes:

How did you hear about us?