Request a Survivor

The Speakers Bureau is a group of over 1500 survivors that represent all different backgrounds and experiences. If you would like to request a survivor to speak at your event or contribute to your project, please fill out the form below. You can also read our Frequently Asked Questions about requesting a survivor to attend an event or support a project.

We recommend you fill out this form about 4 to 6 weeks before your event or deadline. Please provide as much detail as possible about your project or event so that we may find the survivor with the most appropriate experience. You’ll have a chance to confirm or update these details later on in the process.


Contact Information

Event or Interview Request Information:

Date or date range requested:
Event or Project Description:

Event Location:
(If you do NOT need in-person attendance and will be using technology such as video conferencing, please say so.)
Proposed Event Time:
Anticipated Age of Attendees:

Survivor Request Information:

Age Range for Survivor:

(visit Types of Sexual Violence for more information)
*How would you like the speaker to participate in the event?

By checking this box, I agree to respond to any and all survivors who send responses to this request.

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