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 * Best phone number at which to reach you (Please use a10 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 Please select all that apply. What nature of engagement are you interested in connecting with students through? * A classroom career or Lunch and Learn style presentation As part of a Career Day Staff a table at a Career Day Teach Junior Achievement (training and materials provided) Additional types of connections where career knowledge is shared Please check all those that apply 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. If you are registering to present as a classroom career or Lunch and Learn presenter, will you need technology in the room to share a powerpoint, video or other A/V component? Yes No N/A Please select one of the options above. 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 select all that apply. Please share any additional pertinent 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.
