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Speaker or Presentation Request Form

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

  2. Type of Event*

  3. Will there be a video component? Or only audio?*

  4. Will the presenter have slideshow presenting capabilities?*

  5. Eg: Zoom, Microsoft Teams, facebook live, etc.

  6. case workers, residents, students, professionals, church congregation, etc.

  7. Frayser, Binghampton, zip codes 38111 and 38114, Greater Memphis, West Tennessee, etc

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

  9. Division of Community Services

  10. 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

  11. Community Services Agency

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

  12. Crime Victims & Rape Crisis Center

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

  13. Veterans Affairs

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

  14. 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

  15. Leave This Blank:

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