MHA Event/Outreach Request
MHA Event/Outreach Request
Is this an internal Request (are you and MHAOC staff or volunteer)?
*
Yes
No
Staff Name
Staff Name
*
First
Last
Staff Email
*
Supervisor Name
Supervisor Name
*
First
Last
Supervisor Email
*
Do you need support from Community Engagement or Other MHAOC programs to provide coverage for all or part of this event?
*
Yes
No
What staff will be attending the event?
*
Event Contact Name
Event Contact Name
*
First
Last
Event Contact Email
*
Event Contact Phone
Event Contact Phone
*
-
###
-
###
####
Preferred Method of Contact
*
Email
Phone
Text
Lead Event Organization
*
Event Date
Event Date
*
/
MM
/
DD
YYYY
Event Start Time
Event Start Time
*
:
HH
MM
AM
PM
AM/PM
Event End Time
Event End Time
:
HH
MM
AM
PM
AM/PM
Brief Description the Event and what would be expected of MHAOC
*
Audience (size and basic demographics - example: 50 parents of middle school students)
*
Event Flyer
Attach Files