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Chancellor Appearance Request Form

Name of Event: 

Sponsoring Organization: 

Name of Person Requesting: 

Event Location: 

Event Date:   [None] Select a Date Delete the Date

Event Start Time: 

Event End Time: 

Chancellor's Presence Required from:  To: 

Would you like the Chancellor's spouse to attend? 

Would you like the Chancellor's family to attend? 

Who will meet the Chancellor at the event? 

Contact Number for Above Person: 

Dress Code: 

Is there a theme for this event? If so, what is the theme?
 

History of This Event:
 

Expected Attendance: 

Age Group of Audience: 

Any special guests in attendance? If so, who? 

Is the press/media expected to attend? 

Is the Chancellor expected to speak? 

If yes to the above question, please answer the questions below.

What is the group's interest in hearing the Chancellor speak? 
 

Does the group have any special interests or concerns they want the Chancellor to address?
 

Preferred Length of Comments: 

Will there be other speakers? 

If so, who and in what order will they speak?
 

Please submit an official copy of the program/invitation at least three (3) days in advance of event to the Chancellor's office.