Office of the Chancellor

* Name of Event

* Host Department/Organization

* Contact Person

* E-mail

* Office Phone

Cell Phone

Fax

Description of Event

* Day and Date of Event

Attire

* Time of Day

* Place

* Purpose for Visit

* Due to the Chancellor’s schedule, not all requests can be accepted. If he is not able to attend your event, would you like to have your request submitted to a Vice Chancellor for an alternate suggestion?

* Are remarks requested?

If yes, choose one or more
Welcoming remarks, 3-5 minutes
Short remarks, 5-10 minutes
Speech, 15-20 minutes
Major address, 20 minutes +

Topic of remarks

* Will there be other speakers?

If so, who and in what order will they speak?

Number of persons estimated to be in attendance

* Dignitaries in the audience

If so, who?

* Purdue alumni in the audience

If so, who?

* Press/media expected to attend

If so, which media groups will be represented?

For events off-campus, please briefly describe available equipment (e.g., podium, sound system, etc.).

Special notes

Written invitations issued?

By whom?

Expenses of event charged to