REQUEST FOR PRESIDENTIAL PARTICIPATION

Please use this form to request that Dr. Cheryl Evans Jones, President of Paine College speak at an event.

Date of Request:

Department/Organization:

Requesting Person/Point of Contact:

Telephone #:

E-Mail:

Date of Event:

Start Time:

End Time:

Requested Time of Arrival:

Speaking Time Allotted:

Academic Regalia Required:

YesNo

Dress Attire: If so, dress attire:

Address Line 1

Address Line 2

City

Country

State

Provinces

State/Province

Postal Code

Facility being used:

Description of event or activity:

Requested action by President:

Keynote Welcome Remarks Other Description of audience (Briefly describe whom & make-up):

Suggested points to make in remarks:

Requestor Name

Date

Phone Number/Extension

(Dr. Evans Jones requires 2 weeks notice)