Please review the information on our request a speaker page prior to filling out the form below Learn More Speaker Request Form (2023) Today's Date* MM slash DD slash YYYY I have reviewed the FAQs on the "Request a Speaker" webpage.* Yes Contact InformationName* First Last I am a:* Teacher Community organizer Other If Other, please specify: Name of Group / School* Group / School Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your Phone Number*Alternate Phone NumberYour Email* AudienceType of Presentation* In-person Virtual (Zoom) Size of Group*Grade Level / Type of Class* What security measures will you have in place during the speaking engagement?*Preferred Dates / TimesWe recommend a minimum time window of 60 minutes.Option 1 Date* MM slash DD slash YYYY From* : Hours Minutes AM PM AM/PM To* : Hours Minutes AM PM AM/PM Option 2 Date* MM slash DD slash YYYY From* : Hours Minutes AM PM AM/PM To* : Hours Minutes AM PM AM/PM Option 3 Date MM slash DD slash YYYY From : Hours Minutes AM PM AM/PM To : Hours Minutes AM PM AM/PM Have you hosted an AHEC speaker before?* Yes No If yes, who and when? Tell us about your goals for this presentation so that we can find the best speaker for you.*Briefly describe your Holocaust teaching unit.*Questions to consider: how are you planning to prepare your students for the presentation? What themes and stories about the Holocaust have you explored so far? Feel free to mention any specific books/films/other materials you plan to teach.How many years have you been teaching the Holocaust?* How did you hear about us?*Would you like to join our mailing list? General newsletter Teacher/Educator resources Volunteer opportunities Upcoming events