Event or Presentation Request Form - NYC Aging

Department for the Aging


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Event or Presentation Request Form

All requests are required to be submitted at minimum 14 days in advance.

* Indicates required fields

Event Name *

Requester First Name*

Requester Last Name*

Organization Name*

Organization ZIP Code*

Phone(e.g. XXX-XXX-XXXX)*

Email *

Event Date*

Event Time*

Event Borough*

Bronx

Brooklyn

Manhattan

Queens

Staten Island

Event Address/Location *

Event ZIP/Postal Code*

Type of Request *

Presentation

Tabling

Both

Other

Expected Number of Attendees *

Target Audience (Older Adults 60+, Professionals, Caregivers, Agencies, etc.) *

Event Topic *

Elder Justice

Foster Grandparent Program

Friendly Visiting

Health Insurance Information, Counseling, and Assistance Program (HIICAP)

In Home Support

Legal Support

Mental Health Services

NY Connects

Older Adult Workforce Development

Volunteering

General

Other

If Other, Please Specify

Describe the Event or Presentation Requested *

Will you need materials in other languages? *

Yes

No

If Yes, Please Specify

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