Dean's Speaker Request Form Dean's Speaker Request Form This form will assist our staff in coordinating the dean's attendance or participation at your event. This is a two-part process. You must complete this step prior to completing the final event details. *Denotes a required field - We will contact you should there be any questions regarding entry of your event In order to best accommodate your request, please submit the requested information at least 10 weeks prior to the date of the event. Step 1 If this request is accepted by the Dean, then you will be contacted to complete Step 2. Contact Information *First Name: *Last Name: *Business Phone Number: *Mobile Phone Number: *Email: *Name of Organization: Organization's Website Address: Is this a UH event? Yes No Event Information: *Name of Event: *Date of Event: *Event Times Start Time: End Time: *Type of Event: Full address of Location: Sponsored by Cost of Event: Event URL: Desired Role of the Dean (select one) Attendee Only Speaker - Welcome Remarks (3-5 minutes) Only Speaker - Brief Remarks (less than 15 minutes) Speaker - Keynote address (15 minutes or more) Panel Participant Interview or Q&A Other *Objective/Purpose of Event (Please describe in detail): *Number of Guests Expected: Audience Composition (please check all that apply): Students Faculty Staff Alumni Business Leaders Community Members Members of your Organization Only Elected and/or Government Officials (please list in box below) Other (please list in box below)
