Chancellor Request Form

Title of Event:
Purpose/Goals/Importance of the event:
Projected Dates/Times for the event:
Sponsoring Organization
Contact Person: (Office, Cell numbers, email address)
Event Location:
Description of event site:
What would the Chancellor’s role be in the event (i.e. opening remarks, speech, introducing a speaker)? What topics should he address in his remarks?
Who else would be speaking at the event?
What VIPs would be invited?
Number of attendees:
Will media be invited to the event? yes no
Your email address: