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Request Form for Speaker, Presentation, or Table for your Event

  1. Thank you for your interest in having Shelby County Community Services participate in your event. Please complete this form to request our participation.

  2. Type of Event*

  3. Items Provided by the Sponsor*

  4. I would like to have someone speak at this event.*

  5. Check the service(s) below for participation in your event

  6. The Aging Commission

    Adult day care, meals, home modification or repair, legal assistance, medical equipment, elder abuse prevention, senior centers, state health insurance programs, and transportation

  7. Workforce Investment Network (WIN)

    Job training and search tools, career development programs for youth and young adults, and business services to attract and retain employees

  8. Multicultural/Hispanic Affairs

    Assistance and empowerment to all ethnic groups acting as liaison between government agencies and other groups to improve policies, programs, and services

  9. The Community Services Agency

    Utility and mortgage assistance, medical prescription assistance, family support self-sufficiency program

  10. Crime Victims & Rape Crisis Center

    Sexual assault forensic exams and advocacy, counseling, support groups, court appointments, filing for victim’s compensation

  11. Veterans Affairs

    Education and training, guaranty home loans, filing claims, burial benefits, educational assistance for dependents

  12. The Office of Justice Initiatives

    Pretrial Services as alternatives to incarceration for low level crimes including youth. Behavioral Health Unit response to residents with mental illness at any stage of the criminal justice system

  13. Leave This Blank:

  14. This field is not part of the form submission.