Row rect Shape Decorative svg added to bottom Community Outreach and Presentation Form Community Outreach and Presentation Form Email Address(Required)Name(Required)Group or OrganizationEvent or outreach point person if not yourself (please include email as well):What is the audience for your event? (select all that applies)(Required) Older Adults Caregivers Adults with Disabilities Veterans LGBTQ+ Tribal Communities Island Communities Professionals working with any of the populations above (please check off which population this applies to) Other (Type answer in next section) Other Audience TypeHow many people will be in attendance?(Required)What is the date of your event?(Required)We will not consider events that are less than 2 weeks from today. What time is your event?(Required)Please supply details if multiple dates and times:Location of event:Is there a cost associated with our involvement? As a non profit, EAAA has limited funding available and this could impact the decision.(Required)What kind of public education are you looking for? Check all that apply(Required) Community presentation / education Fair Flyers Radio and/or television interview Newspaper or newsletter interview Podcast interview Other (Explain in next section) Other Public EducationWhat is the primary topic of the event and/or what topic are you requesting EAAA to cover? Check all that apply: General Agency Overview Medicare Information Caregiver Services Money Minders Nutrition Services (Home delivered meals, commodity supplemental food program, community cafe) Furry Friends Food Bank Program Wellness and enrichment / Durgin Center Veteran services Other (Please specify in the next section) Other Primary Topic:EAAA will prioritize public education requests based on the mission, vision, area plan, staff capacity, and budget. By completing this form there is no guarantee the education requested will be fulfilled. Within 10 business days of completing this form, the appropriate department director will determine if the request can be fulfilled and assign it appropriately. Please note any additional information you feel would be helpful when the director is determining next steps:CAPTCHA
