Louisiana Office of the Attorney General

Anti-Vaping Presentation Request

Presentation request form for hosting our Anti-Vaping Initiative at your school.

Welcome to our online anti-vaping school information request form. We ask that you include contact information for all of the listed Faculty.

If you have any questions, you may contact our Outreach Division at 1-225-326-6705 or email us at robertsr@ag.louisiana.gov.

Contact Information

School

School Name:

Address:

City:

Parish:

State:

Zip:

Principal

Name:

Email:

Phone:

Vice Principal

Name:

Email:

Phone:

Physical Education Teacher

Name:

Email:

Phone:

Physical Education Teacher

Name:

Email:

Phone:

Office Manager

Office Manager:

Facility Manager / Custodian

FacilityManager:

Presentation Planning

Number of Sixth Grade Students:

Number of Presentations Needed:

Number of Non Physical Education Students Attending:

Will there be another class in the Gym/Auditorium/Cafeteria?

No Yes

Presentation Planning

Gymnasium/Auditorium/Cafeteria Size
We will need 3 tables, preferably 6ft long
Microphone
2 – Chairs
Opt-Out Student Waiver Form (provided by LADOJ)
Number of parking spaces needed for LADOJ representatives: 4