Dean's Speech Request Form

This form has been designed to help coordinate speeches and appearances for Dean Arvind Raman.

If you have questions regarding the form, please contact Jill Vigar at 494-5346 or jvigar@purdue.edu . 

Please submit all requests no later than 3 weeks prior to the date of the event.

Please complete all fields in request.  You should receive a thank you response once the form is submitted.

We will be in touch with you to let you know if the request has been approved.

Date of Event
Start Time
End Time
Location of Event
Description of Event
Main Contact Person
Main Contact Person Office Phone
Main Contact Person E-Mail Address
Main Contact Person Cell Phone
Back-up Contact Person
Back up Contact Person Office Phone
Back up Contact Person Email Address
Back up Contact Person Cell Phone
Are any remarks Requested?
If remarks are requested, please check a description below


What is the topic for the remarks requested?
What is the goal of the event?
Will there be other speakers?
If there are additional speakers, what is the speaking order?
What logistics/items will be provided?
Stage
Yes
No
Microphone
Yes
No
Podium
Yes
No
Powerpoint
Yes
No
Other
Yes
No
Total attendance estimate
Will any Purdue Alumni be in the audience?
If Purdue alumni will be in the audience, please provide an estimate of how many
Will there be students in the audience?
If there are students in the audience, how many?
Will there be any dignitaries present?

If dignitaries will be present, please provide a list of names
Will any press/media be present?

If press will be present, please identify the names of the media group(s)
Were invitations sent out?
If invitations were sent out, by whom?
Sponsoring Department/School/Organization
Dean's Expenses (if any) to be charged to
Additional Comments