Clemson University Online Forms

SpeakOUT Request Form

Thank you for your interest in a SpeakOUT panel from the Gantt Center for Student Life. We offer panels comprised of people representing lesbian, gay, bisexual, transgender, queer, and ally identities. Each panel will consist of three to five speakers who are trained to share their coming out stories and answer the questions of their audience.

Please note that we require three weeks advance notice in order to contact and schedule our speakers. You will receive a confirmation on the week preceding your requested date with the names and contact information of your panel.

* Denotes a required field

Contact Information:

Name: *

First NameLast Name

Email: *

name@example.com

Phone Number: *

-- Ext.

Panel Request Information:

Date: *

/ / (mm/dd/yyyy)

Start Time: *

:

End Time: *

:

Group Name: [Class, Organization, Department, Etc.] *

Location: [Building & Room Number] *

Address:

Line 1
Line 2
, City, State, Zip

Audience Size: *

All of our SpeakOUTs comprise a panel of speakers trained to share their coming out stories. However, we benefit from a number of presenters with unique experiences and interests. If you have a particular interest in a specific content area, please denote in the fields below and we will do our best to populate your panel with any available expertise.


Special Topics:

Bisexuality
Transgender Issues
HIV/AIDS
Parenting/LGBT Families
Intersections with Race
Intersections with Spirituality
Gender Expression
LGBTQ Professionals

Other:

Please share any additional information which may help us design a SpeakOUT which best fits your needs: