Speaking request for the Vice Chancellor of Diversity

Requestor

Name

Pronoun *

he/him/his/his/himself

she/her/her/hers/herself

they/them/their/theirs/themselves

ze/hir/hir/hirs/hirself

E-mail

Contact number

Event Information

Title

Location

Date

Month

Day

Year

Timeframe of entire event

The timeframe the Vice Chancellor is requested

Event Description

General description of the event

Anticipated number of attendees

Intended audience (specify % of students, faculty, staff, community members, etc.)

Topic or Subject

Please provide topics or points you would like for the vice chancellor to address.

Please upload any documents or materials that provide background of the event (i.e. event agenda, flyer, etc.).

Choose a file

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png.

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