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

Grade Level *

Check all that apply

4th

5th

6th

7th

8th

9th

10th

11th

12th

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.

Managing Stress and Anxiety (English)

Managing Stress and Anxiety (Spanish)

Depression and Suicide Prevention (English)

Depression and Suicide Prevention (Spanish)

Road to Resilience

The Teenage Brain: A Work in Progress

Setting Healthy Boundaries

I agree to the following: *

We will have one adult in attendance for every 30 students to monitor and support.

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

We will introduce the presenter to the students.

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.