International Institute of St. Louis
Speaker's Bureau Participant Survey
Please take a moment to record information about your presentation.
Date of Presentation
Name of presenter
Title of Presentation
Name of organization presentation given to.
The speaking engagement was:
Assigned by IISTL
Identified by the Speaker
How many people were in the audience?
Demographic Information of Audience
Please enter the % of audience for ethnicity/race and age.
(Do not enter the % sign. Numbers only.)
White (For example, German, Irish, English, Italian, Polish, French, etc.)
Hispanic. Latino. or Spanish origin (For example, Mexican, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc.)
Black or African American (For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.)
Asian (For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc.)
Middle Eastern or North African (For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc.)
Some other race, ethnicity, or origin
How many were under 18?
How many were 18-64 years of age?
How many were 65 or older?
Questions or Follow-up needed
Were there any questions you could not answer?
Are there any follow up actions needed by Institute staff?
Do Not Fill This Out