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Northern Illinois University

Health Enhancement

Presentation Request Form

Contact Information

Name:  Today's date:
Phone:  Email:
Name of organization/department:

Engagement details

Date requested:  Time:   Location:
Is your request for:
Event/course name:  Anticipated audience size:
Description of event/course:
Are there any specific topics you would like us to address?

For classroom presentations

If this is a classroom presentation, please answer the following:
Will related material be covered in this class prior to the speaking engagement?
If so, briefly describe:
Will the class be informed in advance of the topic(s) of the speaking engagement?