Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address where presentation will take place

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Type of Presentation

Select an option below

In-Person Presentation

Virtual Presentation

Audience

Check all that apply

Teachers/Staff

Administration

Parents

Community

Mental Health Professionals

Requested Date of Presentation *

No more than four presentations per day

MM

DD

YYYY

Please provide a second date option

MM

DD

YYYY

Requested Presentation Topic *

Select only one topic per booking form. Submit an additional booking form if more topics are needed on the same day.

Stress and Anxiety Management: Supporting Youth (English)

Stress and Anxiety Management: Supporting Youth (Spanish)

Depression and Suicide Prevention (English)

Depression and Suicide Prevention (Spanish)

Understanding the Teen Brain: A Work in Progress (English)

Mental Health 101 (English)

Mental Health 101 (Spanish)

Improving Mental Wellness in the Workplace

I agree to the following: *

We will provide easily accessible AV equipment or an AV tech will be available to assist.

We will welcome attendees and introduce the presenter.

We will inform Grant Halliburton Foundation before the presentation about any recent distressing situations, e.g. faculty or student loss, school violence threats, or community turmoil.