Speaker Request Form

Office of the President

Please complete this form with as much information as early as possible and submit no later than six (6) weeks prior to the event. Speaker requests are not considered final until the requestor completes the following form and the President's Office approves.

Note: If out-of-town or overnight travel is required, contact Kathryn Mason in the President's Office at ext. 4521 to submit additional required information.

* All fields are required unless otherwise noted as optional.
REQUESTER INFORMATION
  Contact/Requester:
  Phone Number:
  Email:
  Department/Office:
 
EVENT INFORMATION
  Who's Hosting: (name of person, department, or organization)
 
  Event Title:
  Date of Event:  (mm/dd/yyyy)
  Start Time:  (ex 3:00pm) End Time:  (ex: 3:00pm)
  Location/Address:
  Event Description:
  Provide 4-6 key bullet points for President's remarks.
These points will form the basis of his remarks. Please balance brevity with thoroughness:

 
AUDIENCE INFORMATION
  Targeted Audience
 
Alumni
Board of Trustees
Faculty
General Public
Legislators/Community Leaders (provide names/RSVP list):
Parents
Staff
Students
Other:
  Size of Audience:
  1 - 20   21 - 50   51 - 100   100 - 200   Above 200
 
PRESIDENT INFORMATION
  Type of Presentation:
 
Major Address (20+ minutes)
No Remarks Necessary
Panel Discussion
PowerPoint Presentation Required
Short Remarks (5-10 minutes)
Speech (15-20 minutes)
Time Duration:
Welcoming Remarks (3-5 minutes)
  When will the President be called to speak?
  Who will introduce the President? (please provide the title and brief bio)
 
Title: Brief Bio:
  Will the President be requested to introduce other speakers? YES  NO
If yes, provide name and link to bio.
  Is the President's bio required? YES  NO
  Is a photo required? YES  NO
  If applicable, insert electronic event invitation and/or agenda link here.
 
  Will there be other speakers?  YES  NO
If so, who and in what order will they speak:
  Will there be dignitaries in the audience?  YES  NO
If so, who are the dignitaries?
  Are the press/media expected to attend? YES  NO
If so, which media organizations will be represented:
  Are there notable Stockton alumni in the audience? YES  NO
If so, who?
 
Contact the President's Office (609) 652-4521 with any updates or changes prior to the event.