Chancellor-Dean Participation Request Form

Event/Meeting Name:
Requestor:
Meeting Platform:

ZoomMS TeamIn PersonOther
Date:

MonthDayYear
Date
Start Time:

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Location of Event:
Desired Role of the Chancellor-Dean:
(i.e. attendee, participant, provide brief welcome, speaker, presenter, etc.)
Purpose, History, Background of the Event:
Staff/ Faculty Member Point of Contact Information:
Audience (check all that apply)

PreK- 8thHigh SchoolCollegeFacultyStaffAlumniBusinessCommunityGovernmentLegislatorsOther
Special Guest(s):
Expected Attendance:

0-1920-4950-99100-149150+Other
Please provide agenda/itinerary to the Office of the Chancellor-Dean

Cancelof
Please list any additional notes:
If you have any questions, please do not hesitate to contact the Office of the Chancellor-Dean (jacqueline_dixon@suagcenter.com)
Should be Empty: