Southwest Region Presentation Request Form
Southwest Region Presentation Request Form
Thank you for your interest in learning more about Canine Companions for Independence. We try to accommodate as many presentation and outreach requests as possible throughout the area. Please read through the following information before completing a presentation request form.

We rely heavily on our volunteer puppy raisers and graduates to speak to organizations about Canine Companions. Therefore, our ability to accommodate each request depends on our volunteers schedules and the presentation location. We ask that you please submit your request at least 6 weeks in advance. You may submit your request as early as you like, but please keep in mind we are generally not able to confirm a presenter until a month before the date. If your presentation is part of a conference or larger outreach activity, please explain that in the comments portion of the application. We try our best to arrange for an active assistance dog or puppy in program to accompany the presenter, but if this is not possible we will notify you in advance. Finally, we do try and limit the travel distance for our graduates and puppy raisers, so if we do not have an active volunteer in your area, this might affect our ability to fulfill your request. If we are unable to find a presenter, we can mail you information, including a video, about Canine Companions for Independence.

There is no fee for this service, though we are a 501 C3 non-profit organization and donations are kindly accepted. Please make all donations payable to Canine Companions for Independence.

If you are interested in a presentation, please complete the form below and someone from our staff will follow up with your organization after the information is received.

* required information
Presentation Request Form 

Contact Information
Please complete this form if you are interested in having a representative of Canine Companions for Independence conduct a presentation for your organization.
Name of Group or Business:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
First Name:*
Last Name:*
Phone:*
Email:*
Fax:
Do not email
Do not direct mail
How did you learn about CCI?:
To help us better understand your presentation needs, please complete the following:
Desired Presentation Date:*(mm/dd/yyyy)
Start Time:*
Alternate Presentation Date:(mm/dd/yyyy)
Alternate Presentation Start Time:
Desired presentation length:* 15 minutes
30 minutes
60 minutes
Other
If other, please explain:
Type of Group:
Type of Audience:* Children under 12
Teenagers
Adults
Seniors
Men
Women
Professionals
Students
Number of attendees:*
Provide a brief description of the group/event:
Address of Presentation Location:*
This location is:*
Day-of-Event Contact Name:*
Day-of-Event Contact Phone Number:*
Is the presentation location completely wheelchair accessible?:* yes
no
The presentation will take place:*
Is there a TV/DVD available for showing a short video:* yes
no
I have verified that assistance dogs and puppies in program are permitted and welcome at the presentation location.:* yes
I have verified this location has given consent to host this event on the specified date(s) and time(s).:* yes
Comments:
Thank you very much for your interest in Canine Companions. You will receive a confirmation email upon submitting your request.