ADNW Educational Presentation Request Form
Group/Company/School
Location
Contact Person
Title
Email
Phone Number
Requested Date(s) of Presentation
Time
Size of Group
Average Age
Please briefly describe your goals for the ADNW Educational Presentation and how much time you’d like to allow for the presentation:
Check all that apply:
We don’t know anything about Assistance Dogs
We have some knowledge about Assistance Dogs, but don’t know about the different types.
We know a great deal about Assistance Dogs and the specialized work they perform.
If the presentation is being held at your facility, please check all that apply:
Wifi
Ability to connect a laptop to a TV or Projector
Screen and Projector
For ADNW Office Use Only
Date and Time of Presentation:
Staff and Volunteers conducting the presentation:
Phone Number:
Materials Needed:
Dogs going to Presentation:
Group's knowledge of Assistance Dogs:
Please select...
None
Some
Very well informed
Additional Comments:
Recap of Presentation:
Contact Information