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OPSA Presentation Request
Please fill out this request at least a month prior to your event to give our office the opportunity to review our availability. Completing the form does not guarantee a speaker will be available.
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* Indicates required question
Email
*
Your email
Requested presentation date:
*
MM
/
DD
/
YYYY
Requested presentation start time:
*
Time
:
AM
PM
Requested presentation end time
*
Time
:
AM
PM
Contact Name
*
Your answer
Best Phone Number to Reach You
*
Your answer
Subject, course number, and name of class or group the presentation is for
*
Your answer
How many people are projected to be in attendance?
*
Your answer
How many people are projected to be interested in professional school?
*
Your answer
OPSA currently advises students interested in the following professions. Which profession(s) is the audience interested in hearing about (choose all that apply)?
*
Dentistry
Law
Medical
Nursing
Occupational Therapy (OT)
Pharmacy
Physical Therapy (PT)
Physician Assistant (PA)
Veterinary Medicine
Required
What topics would you like discussed?
*
Your answer
Choose your top preference for presentation delivery:
*
Real-time Zoom
In-person
Recording
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