Event Request Form

Event Request Forms must be submitted at least 2 weeks in advance of the event or we will be unable to accommodate your request.

Name (First, Last)*

First Last

Professional Title*

(example: Mr., Mrs. Ms. Dr., Prof., etc.)

Position*

(example: Professor of ______, PhD Student, Director of ______, etc.)

University/Affiliation*

Email*

Phone*

Website

Your Professional Site or Event Website

Please Attach a Photo of Yourself

Head-shot Preferred

Max. file size: 5 MB.

Date of Event*

Time of Event*

:

Location (if known)

What Kind of Event?*

Colloquium
Seminar
ALUMNI CELEBRATION SPECIAL RESEARCH SESSIONS
ALUMNI CELEBRATION NON-ACADEMIC CAREER PANEL DISCUSSION

Do your require Department funding or reimbursement for this event?*

Yes
No

Please Provide Your Funding String

Fund	Department	Program	Project/Grant

Examples

1) Fund – Department – Program:

101 – 485400 – 2

2) Fund – Department – Program – Project/Grant:

101 – 485400 – 2 – PRJ87XU

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is there anyone in the department you would like to meet with?

Additional information or comments:

For Thesis, Project, or Dissertation Defenses: Name of Advisor*

For Thesis, Project, or Dissertation Defenses: Name of Committee*

Title of Talk/Event Title*

Description/Abstract (150 Word Max.)*

Please DO NOT submit text that was written using LaTeX or any program not typically compatible with Microsoft Office or Adobe Creative Cloud products. If you submit an abstract longer than 150 words – it will be cut short on marketing materials.

Attach Supplementary Material (images, supplementary documents, etc.)

Drop files here or

Max. file size: 5 MB.

If your defense requires a room, please complete a Room Request .