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 STUDENT REQUEST to Present at the KCC Reads Student Conference:

Student Information.
First Name:
**
   Last Name:
**

 
Month in which
you were born: **
 
Cell Phone:
**
 
 
Home Address:
City:  State:  Zip:
Major:  
Expected Graduation: Month:  Year:  

Transfer School:
Student Clubs, other KCC Activities:  
Course Information
In what KCC class did you read the book and complete this Essay/Speech, Poster or Project?
Course Name:
**

 
Section #:  
Semester:  
Year:  
Teacher's Full Name:   
 
Teacher's Dept.:
Details of Your Presentation
Title of Presentation:
 
Type of Session (select one):
 
 

Other (specify):

Brief Description of your Presentation


 
Any time/date restrictions? Indicate preferred times/periods/dates for presentation:
Time(s):

Period(s):

Date(s):

Any Special Needs? Check any that apply--this presentation needs:
A Projector
An easel or
other stand
Copies of a handout
Other:Explain:
Presentation document.
Before Submitting this form, you must upload a copy of your presentation:
Use the browse button to attach your document: Upload box:

 
Please make sure you have browsed to and have selected your document and that it appears in the Upload box before you click the Submit button:

             

** DUE: THURSDAY, APRIL 24TH **