Attestation and Presenter Information Form Please answer all of the questions below. As you complete this form, please be aware that our staff contacts potential presenters directly prior to any scheduling. A Required field First Name * Last Name * Company Name * Your Title * Email Address * Office phone number (Please use a 10 digit format without dashes 58524322223 - include extenstion numbers directly behind the phone number without any letters) * Mobile phone number (Please use a 10 digit format without dashes 5852432222) * Age level of school you are comfortable in presenting to: * Elementary School Middle School High School All of the above We anticipate, as a presenter, that you are typically available Monday through Friday, during school hours. If you have any restrictions: days of the week, time frames on particular days, time of year, etc.; please share details below. For your presentation to students, do you anticipate needing Audio Visual technology to share slides, video, or other components? * Yes No Unsure, will confirm later Do you have an affiliation a particular local district, and if so, which one? * What, if any, is your affiliation * An alumnus A parent of students in the district A business owner or employee within the local community None Schools at which you are willing to present: * Avon Caledonia-Mumford Dansville Geneseo Keshequa Livonia Mt. Morris Wayland Cohocton York All of these Please share any additional information you believe would be valuable I attest that I have watched and will comply with the guidance outlined in the presenter webinar. * Select option... Agree Selecting "Agree" in the dropdown box above provides your confirmation of viewership.
