Community Engagement Request Form

Thank you very much for your interest in learning more about ICAN. We are thrilled to share our mission of unleashing abilities with your group or event. We provide educational presentations on the impact of service dogs on those living with disabilities. To facilitate our ability to tailor our program to your needs, please complete the form below and a member of our team will reach out to you.

Contact Info

Company/Organization

Organization website

Contact Name

Contact Phone

Contact Email

Event Info

Event Location Address

Parking Information and detailed directions to enter building:

Preferred Date/Time

Use the following format: 01/01/2024 01:30 PM

Alternate Date/Time

Use the following format: 01/01/2024 01:30 PM

Is this date flexible?

Is this time flexible?

Type of Outreach Programming Requested

ICAN provides several types of outreach programming based on your needs. This includes speaker presentations for adults and children and table/booth set ups and demonstrations for fairs and community events. While there is never a fee to share our passion with your group, if your location is more than 50 miles from our office (5100 Charles Court Suite 100, Zionsville, IN 46077), an honorarium would be appreciated.

If you are looking for a bit more interaction, check out our Puppy Love Year Round Deliveries. This special presentation through our ICAN Ambassador program can be tailored to your needs to celebrate special events including anniversaries and birthdays for individuals, delivering special gifts to a company's clients or employees, or meet and greets for employee appreciation. A minimum donation is required. A Puppy Love representative will follow up with you to customize your delivery.

Please select the presentation that meets your needs:

Presentation/event duration:

Expected Attendance

Is there a screen and projector available?

Will a table/chairs be provided?

For Puppy Love Year Round deliveries, what is the delivery setting:

For Puppy Love Year Round deliveries, what is the reason for delivery:

If you selected other, please explain:

Honorarium

Any donation is appreciated and allows us to continue these educational programs. Honorariums can be sent though our website, presented to the speaker, or mailed to our ICAN Zionsville office.

https://donate.onecause.com/icandonate/donate

ICAN

5100 Charles Court Suite 100

Zionsville, IN 46077

For Companies, do you have an employee match program that can be highlighted during our presentation?

Additional information you would like us to know:

For questions, email

Lori Ann Steininger

Development and Community Outreach Manager

loris@icandog.org

Contact Information