1 Contact Information2 Event Information3 Audience Information4 Additional Information This form has been provided to help coordinate appearances, speeches and other requests of the provost. Your request must be submitted online using the form below. Please keep in mind that the provost’s schedule is very demanding and is subject to change at any time in the event of emergencies or important university business. If such situations affect the provost’s attendance at your event, a member of our staff will contact you, and when possible we will provide a representative, if you wish. In the event of agenda or timing changes, we ask that you contact our office immediately at 407-823-2698. You must submit your request four weeks in advance of your event. If you have questions concerning this information, please contact our office at 407-823-2698. Thank you for your cooperation.Requester InformationName* First Last Email* Phone*Mobile PhoneIs this a college/school event?*YesNoSelect college/school*Burnett Honors CollegeCollege of Arts and HumanitiesCollege of Business AdministrationCollege of Community Innovation and EducationCollege of Engineering and Computer ScienceCollege of Graduate StudiesCollege of Health Professions and SciencesCollege of MedicineCollege of NursingCollege of Optics and PhotonicsCollege of SciencesCollege of Undergraduate StudiesNicholson School of Communication and MediaRosen College of Hospitality ManagementAcademic Program Quality/IKMDigital LearningFaculty ExcellenceOffice of ResearchStudent Development and Enrollment ServicesTeaching and LearningUCF Connect/UCF GlobalOtherDepartment* Event InformationNeed more information on the Provost? The Provost Press Kit comes with a short and long bio and pictures.Name of Event*Sponsoring OrganizationDate of Event* Date Format: MM slash DD slash YYYY Start Time* : HH MM AM PM End Time* : HH MM AM PM Internal Event Location*Burnett HouseClassroom Building IIFairwinds Alumni CenterFerrell CommonsStudent UnionLive OakMorgridge International Reading CenterTeaching AcademyThe VenueUCF ArenaUCF GlobalOtherEvent Location*Room NumberEvent Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Drive time to location from UCFParking instructions/informationDescription of Event*Purpose of Event*Expected Outcome*Desired provost arrival time? : HH MM AM PM How long is the provost expected to stay?Are Remarks Requested?*YesNoType of Remarks*2-5 minutes5-10 minutes10-20 minutesInterviewOtherOther (Describe)Recommended topics the provost should addressWill the following be provided* Rostrum (podium) Stationary mic Handheld mic Label mic Drop mic Who is the point of contact for the provost at the event?*Point of contact cell number*Who will introduce the provost? (name and title) Audience InformationOpen to the public?*YesNoAudience Type? Please check all that apply* Dignitaries UCF Faculty UCF Students UCF Staff UCF Alumni UCF Trustees Press/Media Names of media groups represented: Additional InformationIf, for any reason, the provost is unable to speak on the requested date, will you accept an alternate speaker from the University of Central Florida?* Yes No Expenses of the event charged toAny other important details?EmailThis field is for validation purposes and should be left unchanged.