Appearance Request Form

Thank you for your interest in inviting Chancellor Mo Dehghani, Ph.D., to speak at or attend your meeting or event. Before completing the request form below, please contact the Office of the Chancellor with your invitation. The Office of the Chancellor attempts to accommodate as many requests as possible, but dates fill up quickly, so please submit your request at least 60 days in advance.

Please note that filling out this form does not guarantee an appearance by the chancellor or a representative of the chancellor. The Office of the Chancellor attempts to accommodate most requests that support the mission of the university, however all requests are subject to availability.

  • Before completing this form, please contact the Office of the Chancellor with your invitation.
  • To assist the chancellor in serving your needs, please complete and submit this online form.

Speaking requests: Please fill out all fields.

Appearance-only requests: Please fill out fields marked with an asterisk (*).

1. * Name of event

2. * Brief description of event

3. * What role will the chancellor play in the event (present awards, participate in groundbreaking, welcome attendees, etc.)?

 4. * Description of sponsoring organization(s) for event

5. * Date of event

6. * Preferred arrival time

7. * Start time

8. * End time

9. * Event address

10. * Room name or number

11. * Parking arrangements and specifications

12. * Website for event and/or organization

13. * Event attire
Formal Business Business casual Informal

14. * Order of events

 15. * Number of attendees and composition (students, faculty, alumni, public officials, etc.)

16. * Key people to meet and greet

17. * Phonetic pronunciation of names/key people

 

 If this is an appearance-only request, skip to question 28. For all speaking requests, please also answer questions 18-27.

 

18. When will the chancellor be called to speak?

19. Preferred length of speech
Brief: 5 min or less Intermediate: 6-10 min Major: 10-15 min
Other (specify)

20. Speech format (check all that apply)
Informal
Formal
Roundtable format
Chancellor will speak from podium
Microphone available
Projector/computer available for slides

21. Type of remarks requested
Welcome
Introduction
Remarks
Keynote
Panel
Other (specify)


22. Chancellor will be introduced by:

23. Will the chancellor introduce anyone?
Provide their full name, pronunciation if needed, title, and a short bio. (Leave blank if no introductions are necessary.)

24. Question-and-answer session following speech?
YesNo

25. Suggested main points:
 Is there a particular topic that should be addressed? Does the group have any special causes or concerns to be addressed?

26. Other speakers (include name and title)

27. Key people to acknowledge in remarks

 

28. * On-site contact name and cell phone number (example: John Smith 573-555-5555)

Form Completed By

29. * Name, title

30. * Email

31. * Phone (example: 573-555-5555)

32. * Date


 

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