Approved:  04/15/1991

Revised:    03/16/2009                                                                                                 355.2 Exhibit

School District of Prairie Farm

Resource Speaker Request Form

RESOURCE SPEAKER REQUEST FORM

Submit in Duplicate

COURSE:__________________________________________________________________

DATE/DATES DESIRED:_____________________________________________________

NAME OF RESOURCE SPEAKER:_____________________________________________

ORGANIZATION OR ORGANIZATIONS THAT HE/SHE REPRESENTS:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

TOPIC YOU WISH PRESENTED:_______________________________________________

____________________________________________________________________________

____________________________________________________________________________

SUMMARIZATION OF PURPOSE AND MATERIAL YOU WISH HIM/HER TO PRESENT:

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

RECOMMENDED BY:____________________________________________(Teacher's Name)

APPROVED BY:__________________________________________ DATE:_______________

                                                            Principal

COMMENTS:__________________________________________________________________

______________________________________________________________________________