Director’s Office – Speaker Request Form Director's Office - Speaker Request Form Submit form to request a speaker for an event. Requesting Organization* Date of Event* MM slash DD slash YYYY Time of Event* : Hours Minutes AM PM Location of EventType of Request* Keynote Plenary Welcome Remarks Testimony/Hearing Panel Closing Remarks Talking Points Can this presentation be completed virtually?* Yes No Who will be in the audience?*For example, business leaders, higher education leaders, policymakers, faculty members, community leaders, etc.Potential Audience Size* 25 or less 26-50 51-75 100+ Other Subject or focus of talk/presentation:*What do you want the audience to do with the information shared?*Requested Speaker Dr. Jeff Hyde Dr. Angela Burkham Dr. Dan Hale Dr. Jeff Ripley Dr. Courtney Dodd How long do you expect the presenter to speak?*The ideal length is usually 20 minutes, plus Q&AYour Information*Contact Name: Contact Title* Email* Phone*Include Area CodeAny Additional details we should know?