Speaker Request Form

Please fill out Request Form at least 2 weeks prior to the date of the engagement. If you wish to schedule a BARCC speaker and your event is less than 2 weeks from today, please call our office at 617-492-8306 and ask to speak with the Coordinator of Community Awareness and Outreach.

Please provide the following information. You will be contacted within 2 business days to confirm details and particulars of your request.

* indicates required fields

Name of organization *

Organization department or unit

Contact person *

Contact phone *

Contact email *

Mailing address *

Location of engagement *

Requested Program *
Please select one Respecting Boundaries (45-60 min) Sexual Assault: Practicing Prevention (1-1.5 hours) Becoming Active Bystanders (2-2.5 hours) First Responders (1-2.5 hours)

Date of engagement *

Start time *

Intended audience *

Estimated group size *

How did you hear about BARCC? *

BARCC does provide speakers and educators at no cost but because we are a non-profit organization with a limited budget, we will ask that, if your organization is able, you make a donation to support our work.

24-hour hotline: 800.841.8371