Peace Corps

Request for a Speaker

Enhance your students' learning in almost any subject area. There are returned Peace Corps Volunteers from every region of the world who have worked at the grassroots level. Their stories, projects, and experiences can provide U.S. students with unusually candid firsthand perspectives of cultures worldwide, views not usually accessible through textbooks, films, and other familiar media.

To request a speaker for your classroom, please fill out the form below. Be sure to list any preferences you have for your Peace Corps Volunteer's region or area of expertise!

Teacher  
School  
Address1  
Address2  
City  
State  
ZIP Code  
County  
Work phone  
Home phone  
Fax  
E-mail  
Grade level  
Number of students  
Presentation Date  
 
Details about speaking event:
 
Request for Volunteer (region, program, sector, etc.) :
 
 
   
OMB Approval Number 0420-0539
Expiration Date: 12.04.10

PC-964

Privacy Act Notice: Authority to request this information is the Peace Corps Act {22 U.S.C. §2501 et seq.} (as amended). This information will be used in processing your enrollment in the Speakers Match program. This information may be used for the routine uses described in the Privacy Act, 5 U.S.C. 552a, and in the Federal Register at 65 Fed. Reg. 53,722 ( September 5, 2000 ) and 50 Fed. Reg. 1950, 1962 ( January 14, 1985 ) regarding Peace Corps systems of records.   Disclosure of this information is voluntary. Failure to provide sufficient information may preclude your consideration for Speakers Match.

Paperwork Reduction Act Burden paragraph per 5 CFR Part 1320(b)(3): This is a voluntary information collection.  The estimated burden for completing this form is 10 minutes.  You are not required to respond to any collection of information unless it displays a currently valid OMB approval number.  Comments on the burden should be sent to: the director of Peace Corps Coverdell World Wise Schools, 1111 20th Street, NW, 2nd Floor, Washington, D.C. 20526 and to the Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C. 20503.

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