Book A Presentation

YOUR INFORMATION

Name *

First

Last

Email *

Email

Confirm Email

Contact Phone Number

School/Organization Name(s) *

School District *

(enter N/A if not applicable)

Anonymous Reporting Tool Used *

(enter "I don't know" if unsure or N/A if not applicable)

LOCATION AND DATE

Presentation style *

Virtual

Physical Address *

Address Line 1

Address Line 2

City

State

Zip Code

STUDENT PRESENTATION (CHECK ALL THAT APPLY) *

Please let us know how many attendees for each of the student presentations selected above.

K-1 - Number of Attendees *

2-3 - Number of Attendees *

4-5 - Number of Attendees *

6-8 - Number of Attendees *

9-12 - Number of Attendees *

ADULT PRESENTATION 45-60 MINUTES (CHECK ALL THAT APPLY) *

Parents
Educators
Community
NOT Applicable

Please let us know how many attendees for each of the adult presentations selected above.

Parents - Number of Attendees *

Educators - Number of Attendees *

Community - Number of Attendees *

Date / Time (Option 1) *

Date

Time

Date / Time (Option 2) *

Date

Time

Reason for presentation request (this data helps us understand your presentation needs) *

Educational
Campus experiencing cyberbullying
Professional development (educators)

Does your campus currently have an anti-bullying program and/or club? *

Yes
No

What outcome(s) would you like to see after hearing the David's Legacy Foundation presentation? (check all that apply) *

Awareness and understanding of Cyberbullying
Awareness and understanding of David's Law
Change in behavior

YOUR INFORMATION

LOCATION AND DATE