Outreach Request Form Your name Organization Phone number Email Name of the event Date of the event Event format - Select -In PersonHybridVirtual Event location Virtual meeting platform Type of event - Select -PresentationWorkshop/TrainingTable/BoothOnsite Technical Assistance How much time will be allotted for the presentation or engagement? Is this a recurring event? Yes No Primary audience Primary audience - None -PublicSmall and Diverse BusinessState Agencies/Higher EducationMembers of Your OrganizationLocal Governments, Ports, Transit, EtcOther… Enter other… How many attendees do you expect at this event? Will you need information in a language(s) other than English? Yes No If yes, what is the preferred language(s) Will there be an ASL interpreter at the event? Yes No Have there been any additional requests for accommodations that we should know about? Are there any other details that you would like to share about this event? CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
