Submit an Inquiry to Dr. Amin

NOTE: this page should be completed for those interested in keynote speaking engagements, workshops and/or curriculum consulting with Dr. Amin, For all other services, please submit the application here.

Name *

Title *

Preferred Pronouns *

Name of Institution/Organization *

Email *

Preferred Phone Number *

Nature of request: *

Keynote Speaking Engagement
Workshop Presentation
Curriculum Consultation
Other

Please describe the nature of your request in as much detail as possible *

Describe the audience/participants related to this request, including the number of persons involved *

Are you the person in-charge of approving this request? *

*If not, who is ultimately in charge of approving this request?

What are the proposed dates/timeline pursuant to this request? *

Additional details related to this request

If this event/process has occurred in the past, whose services were employed to meet those needs? *

How urgent is this current inquiry pursuant to meeting organizational/institutional goals? *

What are the desired outcomes for this event/consultation? *

Complimentary consultations in response to submitted inquiries last about 45-60mins. Can you make time within the next 48 hours to speak by phone, if your inquiry looks like a good fit for Black Girl Brilliance, LLC./Dr. Amin? *

Website

Before submitting this request, please note:

Ticket sales are prohibited without the permission of Takiyah Nur Amin, PhD/Black Girl Brilliance, LLC.
Recording of speaker is prohibited without the permission of Takiyah Nur Amin PhD/Black Girl Brilliance, LLC.
Presentation: All Audio/Visual resources must be provided by host/booking entity
Travel Proviso: all flight, ground and hotel arrangements must be approved by Takiyah Nur Amin PhD/Black Girl Brilliance, LLC prior to booking
Additional terms will be assessed once this inquiry has been received and approved