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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.