Isleta Health Center Presentation Request

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If you would like the Isleta Health Center Staff to provide a presentation, please complete this form. We will try our best to accommodate your needs, however, please understand there may be some limitations. Please contact Stephanie Barela, (505) 869-4479 or stephanie.barela@islclinic.net if you have any questions.

Email *

Presentation/Topic Requesting:

Intent/Purpose:

Audience (Estimated description, i.e. Elders, Parents, Kinder, Staff, etc):

Elders

Parents

Students

Staff

Community

Other:

Clear selection

Audience (Estimated Number):

Is this Training a Requirement for your staff?

Yes

Other:

Clear selection

If yes, who is the requirement from?

Outcome Wanted:

Date/Time Requesting:

Location of Presentation:

Audio Visual Equipment Available (I.E. PowerPoint projector/Laptop, Smart board, etc):

Additional Information Presenter May Need:

Department Requesting:

Isleta Elders Center

Isleta Assisted Living

Isleta Head Start and Child Care

Isleta Elementary School

Other:

Clear selection

Department Representative Name and Title: *

Representative Phone Number *

Representative Email *

THANK YOU FOR COMPLETING THIS FORM!

Please email me to let me know that a form was submitted, by emailing me at Stephanie.Barela@islclinic.net.

Send me a copy of my responses.

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