Attendance and Speech Request Form You must have JavaScript enabled to use this form. VP Olivérez is delighted to attend events and programs and to provide welcome, introductory, or keynote remarks. Please submit the following form to request Vice President Olivérez's availability to attend and/or speak at your event. The Vice President's Office attempts to accommodate most requests to support the mission of the university and appreciates your patience with the VPSA's complex calendar. We ask that you complete this form at least two weeks in advance of your event/program. Thank you so much! Contact Information What is your name or the event organizer's name? What is your email address? What is your phone number? Campus Affiliation Staff Faculty Student Community Area AVP/AD/Director Beth Jaworski Shawn Chin-Farrell Daria-Yvonne Jackson Graham Molly Springer Lisa Root Event Information What is the Event/Program Title? What is the Purpose of the Event/Program? Please provide a detailed description of the event What is the Date of Event/Program? Is this an annual event? Yes No What time does the event/program begin? How long is the program/event expected to last? Where will the event be held? (Location/address, if off campus) Who is the Expected Audience (student, faculty, staff, organization, etc)? Please Share the Number of Expected Attendees Please Share VP Olivérez 's Expected Role Speaking Non Speaking Please share specified speaking role Welcome Remarks Brief Remarks Featured Keynote Speaker Panelist Master of Ceremonies Other… Enter other… What time is VP Olivérez expected to speak? Who will introduce VP Olivérez to speak? Expected duration of VP Olivérez remarks Will other DSA AVPs attend? Have other VPs or the President been invited to attend? Please list additional confirmed event/program speakers here Please share full listing of event/program committee names Please share list of other individuals, departments or organizations VP Olivérez should thank in her remarks Will any elected officials be in the audience? If so, please list them individually Please share at least two speaking points here. Please be as specific and thorough as possible. Please upload event program and/or supporting documents here. One file only.2 MB limit.Allowed types: gif, jpg, png, pdf, doc, docx.2 MB limit per form.