Form PC-DP.969.4 Speakers Match: Request for a Speaker

Request a Speaker

Enhance your students' learning in almost any subject area by inviting a returned Peace Corps Volunteer (RPCV) to speak with them. Their stories, projects, and experiences can provide U.S. students with in-depth, firsthand perspectives of global cultures and views not usually accessible through textbooks, films, or other media.

Invite an RPCV to your school or classroom by filling out the form below.

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* Teacher:

* School:

* Address 1:

Address 2:

* City:

* State:

* ZIP Code:

* Work phone:

Alt. phone:

* Email:

* Grade level:

* Number of students:

* Presentation Date (if known):

* Presentation Time (if known):

Details about speaking event:

Special Requests for Volunteer (region, area of expertise, language, etc.):

How did you learn about this program?

OMB Control Number 0420-0539

Expiration Date: X/XX/2014

Privacy Act Notice: This information is being collected pursuant to 22 U.S.C. 2501(a). This information will be used in processing your enrollment in the Speakers Match program. Disclosure of this information is voluntary. Failure to provide sufficient information may preclude your consideration for Speakers Match. This information may be used for the routine uses described in the Privacy Act, 5 U.S.C. 552a, and the Peace Corps' published Routine Uses, summarized in Peace Corps' System of Records.

Paperwork Reduction Act Burden Statement: Public reporting burden for this information collection is estimated to average 10 minutes. This includes the time for reviewing instructions and completing the information. This is voluntary information collection. An agency may not conduct or sponsor, and persons are not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: the FOIA Officer, Peace Corps, 1111 20^th Street NW, 2^nd Floor, Washington, D.C. 20526.

PC-DP.969.4 (Rev. 04/2014)

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