Presentation Requests

GHDC Presentation Request Form

Thank you for your interest in having members of the Greensboro Health Disparities Collaborative speak with your group. We welcome opportunities to share and discuss our work!

Please answer the following questions so that we can learn more about your request. Please note that we always send at least two members to give presentations to outside groups to ensure that presenters reflect diverse perspectives within our Collaborative. We ask that requests be submitted at least one month before the proposed presentation date.

GHDC Presentation Request Form (PDF)

* Indicates required field

Date *

Contact Person (GHDC member) for this Proposal *

If you do not yet have a GHDC contact, leave blank

Requestor's Name *

First

Last

Email *

Organization *

Phone *

Description of Presentation Host *

Intended Audience *

(e.g. community group, students, health professionals, researchers)

(e.g. conference, class or public forum. If applicable, please include
the amount of time allotted for the presentation.)

Proposed Presentation Date *

Preparation Timeline *

(Please include date by which materials must be finalized.)

Presentation Title *

Lead Presenter(s) *

(If known at this point)

Proposed Supportive Others Including Role *

Summary Description and Importance *

(e.g. co-authors, co-presenters or contributors, if applicable)

Data Sources Requested (if applicable) *

Technical Assistance Needed (if applicable) *

Funding Provided *

(If applicable, for travel expenses and stipends for presenters)

Submit

​GHDC Presentation Request Form

GHDC Presentation Request Form