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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:
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 #:  
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:



Any Special Needs? Check any that apply--this presentation needs:
A Projector
An easel or
other stand
Copies of a handout
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 23RD, 2015 **