Presenter Interest Form

Presenter Title:

Mr. Ms. Mrs.

Presenter Name:

First Name
Middle Initial
Last Name
Presenter Contact Information:

Address
City
State
Zip
Work Phone
Home Phone
Cell Phone
Email
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Please complete the appropriate section below.

Student

School
Major or Discipline
Expected Graduation Date
Degree
Faculty/Academic Staff

School
Department
Specialization
Professional/Community Member

Employer
Job Title
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Community Affiliations: Please list any relevant memberships or volunteer associations

International Experience:

Country of Origin
Language(s) spoken
Please list the countries lived/worked/traveled/studied in and length of time there:

Presentation Topics:

Arts Crafts Culture Current Events
Development Foreign Policy Geography Health
History Holidays Language Lifestyle
Music Politics Religion Traditions

Type of Presentation(s):

oral presentation
demonstration
cultural performance

Have you worked with the K-12 Outreach Program in the past?

Yes
No

How did you first learn of the K-12 Outreach Program?

Thank you for your help with the K-12 Outreach Program. If you have questions, please contact us at k12outreach@unc.edu or (919) 962-6860.

When you have entered your information, please click "submit" below.


This questionnaire was created using Perseus SurveySolutions.