Speaker Request Form

When I was the Humane Educator for Bridges of Respect, I completed this form for every teacher who invited me in to speak at their school–usually over the phone with them. This form ensured I had all the information I needed to provide a good presentation for their students. It also made sure I let them know what to expect from us and what was required of them. I encourage all itinerant humane educators to use a form like this. Feel free to model your form after this one. Here is the Speaker Request Form as a Word file so you can download it and modify it to suit your needs. For those of you who do not have the program Word, here is its text.

Speaker Request Form

Name: _____________________________________________
Grade: ________ Subject: _______________ Room: _______
School: ____________________________________________
Street Address: ______________________________________
City: _____________________ State: ______ Zip: __________
Work Phone: _________________________________________
Home Phone: ________________________________________
E-mail: ______________________________________________
Programs Requested: [ ] [ ] [ ] [ ] [ ] [ ]
How they learned about Bridges: _________________________

Date Form Completed: _________________________________

Questions for Teachers

How many classes will I be speaking to per visit? (Preference is given to schools who request multiple presentations per visit.) ______

What times do the classes start and end? How many students are in each class? and what grade level are the students (in each class)?

Does the classroom have a: TV and VCR? ______ Overhead projector? ______

Which dates work best for you, and what program will be given on each date?

What are the directions to your school?

Is there anything you think I should know about the students: their motivation level? their participation habits? unique aspects? etc.?

Is there any thing else you would like to tell me that will be helpful for me?

• Will you be in the room during my presentation? If not, I need the name of the teacher and their contact information so I can speak to them. We require that you (the host teacher) be in the room at ALL times during the program. Are you prepared to meet this requirement?”

• “Bridges of Respect is a humane education program that seeks to build critical thinking skills while promoting compassion and respect for the environment and animals. One of the ways we develop critical thinking is by exposing students to new ideas and challenging their way of thinking. All of this is done in a respectful and non-judgmental manner. We make it clear from the beginning that we are not telling them what to think, what to believe, or how to behave, but offering them the information for their consideration. Now, In the program that you requested, some of the issues that typically come up include… How does this sound?”

• Use the notes section or the back of this form to write any relevant comments.

• Do you have any more questions?