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Speaker or Presentation Request Form

  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. Will this be in-person or virtual?*
  4. Will the presenter have slideshow capabilities?*
  5. Street Address, City, State, Zip-code

  6. Items provided by organization:*
  7. Eg: Zoom, GoToMeeting, Microsoft Teams...

  8. Staff Members, Residents, Church Congregation, Students, etc.

  9. Frayser, South Memphis or Zip codes: 38127, 38126, 38119

  10. Check the service(s) below that you would like to participate in your event:
  11. The Aging Commission

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

  12. Community Services Agency

    Rent/mortgage, utility, medical prescription assistance, and family support self-sufficiency program

  13. Crime Victims & Rape Crisis Center

    Sexual assault forensic exams and advocacy, counseling, support groups, court accompaniment, filling for victim's compensation 

  14. Veteran Services

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

  15. The Office of Justice Initiatives

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

  16. Leave This Blank:

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