SpeechLyss Presentation Request Form
Hello! Thank you so much for your interest in a presentation by Alyssa Antcliff, M.S., CCC-SLP, owner and grad school application coach at https://speechlyss.com.

I am so excited to present to your organization! The grad school application process is stressful and complex, and I would love to help guide your students through it.

Please complete the form to the best of your ability, and I will reach out via email within 5 business days to confirm a date and time. Presentation requests must be submitted at least 2 weeks prior to the requested presentation date.

All presentations are virtual unless your university/organization is within 2 hours of Indianapolis, IN and an in-person presentation is specifically requested. There are compensation fees for travel requests.

Please send me the meeting link you'd prefer for our presentation upon sign up, or at least 1 day before the presentation. If you'd prefer I set up the presentation, include that in the comments section below and I will send you a meeting link when I confirm your date and time.

Email me at hello@speechlyss.com if you have any questions regarding the presentation or this form. Thank you very much!

**Please note: if you would like Alyssa to participate as a part of a round table or panel, please indicate this in the comments/questions section at the bottom of this form. Additionally, if you would like Alyssa to present more than once (e.g., one topic relevant to current grad school applicants & one broader grad app/grad school/SLP topic), please indicate that as well. Thank you!**
Sign in to Google to save your progress. Learn more
Name of person completing this form (or name of person who confirmation will be sent to if different) *
Email address (where confirmation will be sent) *
Name of your organization and location/university (e.g., NSSLHA at XYZ University)
Preferred Presentation Date (1) *
MM
/
DD
/
YYYY
Preferred Presentation Times (1) - include time zone (e.g., "3:00 or 4:00 PM EST") *
Alternative Presentation Date (2)
MM
/
DD
/
YYYY
Alternative Presentation Time (2) - include time zone
Alternative Presentation Date (3)
MM
/
DD
/
YYYY
Alternative Presentation Time (3) - include time zone
Preferred Presentation Topic (e.g., "Grad school applications" or "SLP life" or "private practice" etc.) *
Comments / questions (these will be addressed via email)
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of SpeechLyss, LLC. Report Abuse