| Date of Request: |
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| Company: |
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| Request made by (include name/title/position): |
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| Type of Service Requested: |
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| |
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| Topic or type of service requested |
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| Objectives to be met or results desired by Company |
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| Why are these results desired by Company |
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| Who is the intended audience |
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| Does this involve change in Company policy/practices?
Describe. |
Yes
No
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| Is the proposed training or other service provided going
to be mandatory for a Company audience? If so, why? |
Yes
No
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| Describe any relevant organizational context
(administrative/executive/managerial changes, reduction in force,
employee morale issues, political environment, etc.) |
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| Are there restrictions to the length of presentation?
If so, what is the desired length of the presentation? |
Yes
No
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| What timeline does the Company desire? |
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| Where would services need to be provided? |
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| If onsite at Company facility, what are the presenter's
responsibilities for the program logistics (handouts, set-up, media
hardware, etc.)? |
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| Other considerations, information, variables, etc. |
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| Are you willing to complete an online Speakers Bureau
survey at the completion of the presentation? |
Yes
No |