Dean's Speaker Request Form (virtual appearances) While social distancing and other COVID-19 events remain present, the CLASS dean will still be available to speak, but all events will be held in a virtual format. Due to the many demands on the dean’s time, we request that you submit this form so that he can manage the commitments and schedule his participation accordingly. This form will assist our staff in coordinating the dean's 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 4-6 weeks prior to the date of the event. Step 1 Only if this request is accepted by the dean will you be contacted to complete Step 2. Do not proceed to Step 2 unless you are notified. Contact Information of Requester *First Name: *Last Name: *Business Phone Number: *Mobile Phone Number: *Email: *Name of Department/Organization: *Department/Organization Website Address: *Has this event been approved by the department chair? Yes No How will the event be held? (Please include contact link.) Zoom Teams Webinar Telephone conference call Other Event Information: *Name of Event: *Date of Event: *Number of participants expected: *Start Time: *End Time: *Type of Event (e.g. lecture, workshop, conference, panel discussion, etc.): Full address of location, if applicable: *Sponsored by: *Please send event flyer, brochure, poster and other supporting marketing collateral to CLASS Communications. Event URL: Desired Role of the Dean (select one) Speaker – Welcome Remarks (3–5 minutes) Speaker – Brief Remarks (less than 15 minutes) Speaker – Keynote Address (15 minutes or more) Panel Participant Interview or Q&A Closing Remarks Other *Objective/Purpose of Event (Describe in one or two sentences.): Success Metrics (Please check all that apply.): FTIC retention rate FTIC 6-year graduation rates FTIC 4-year graduation rates Total semester credit hours (SCH) B.A./B.S. degrees awarded Ph.D. degrees awarded Externally sponsored research proposals Externally sponsored research awards Externally sponsored research expenditures Published articles and citations Published books, chapters and book-length and article-length creative works Faculty national awards (NRC/AAU and TARU) Total annual giving Community-engaged research awards, events, or co-curricular activities Other (Please list in box below.) 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 Other (Please list in box below.)