Speaker/Workshop Request Form

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CCWS does not provide speakers/facilitators for child protection agencies. Child protection workers can refer children and youth to CCWS to participate in our programming.

CCWS provides talks and workshops related to child welfare. Please see website for more information on the topics we currently speak/facilitate on.

Due to COVID-19 all speaking/facilitation is virtual.

Date *

YYYY

What is the name of the organization, institution, and/or group? *

Name and pronouns of contact person *

Please provide an email *

Please provide a phone number *

Describe the kind of speaking event *

What is the age group? Check all that apply *

12-18

18-25

25+

Required

Are child welfare survivors a part of the group/audience? *

Yes

Don't Know

If so, how many?

1-5

5-10

10-20

20+

Clear selection

Please describe the group, such as racial identity, profession affiliation (post-secondary class, conference) *

Describe the topics are you interested *

Please provide dates and times you are interested in? *

Will you provide materials (Zoom/virtual link. If not, CCWS does have Zoom and can provide a link). *

Yes

Please provide any accessibility requirements *

Submit

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