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Chancellor’s Speaking Engagement Request Form

If you would like to request the Chancellor's appearance at a speaking engagement or event, please fill out the following form completely. Once we review your details, someone from the Chancellor's Office will be in touch with the contact person you enter on the form. We ask that all requests be made at least 3 weeks in advance of the requested event date to allow us time for processing, planning and scheduling.

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What is the first and last name of the contact person for this request?

What is your official title?

What is the best way to contact you? *

Phone

Email

Phone & Email

Phone Number

Email Address

Phone Number and Email *

What organization or agency do you represent/work for?

What is the title of the speaking engagement?

When will this event occur? Please enter the prospective date if not yet set.

Month

Day

Year

Please provide a brief description of the theme of the event and what topics you would want the Chancellor to touch on.

What is the expected size of the audience for the event?

Who will the audience be comprised of, i.e. students, community members, donors, trustees or board members, etc.?

How long will the Chancellor's speech need to be?

Enter any further details for the Chancellor's consideration.

Leave this field blank

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Chancellor’s Speaking Engagement Request Form

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