Convo Select Information Form

Upon reviewing this request, LU Stages assumes that all guests and topics have been approved by the Dean of the school and the Provost's office.

If you have more than one guest, you will need to submit two forms.

Please DO NOT invite guests until final approval from LU Stages has been acquired.

What is your name? *

What is your job title? *

What department/school are you contacting us from? *

E-mail *

example@example.com

Phone Number *

Area Code Phone Number

Is your speaker a representative of an organization other than Liberty University? *

Yes No

Are they speaking on behalf of the organization to promote opportunities for current Liberty students to participate in? *

Yes No

Name of Company or Organization? *

Main Website (Link) *

Please share with us about any previous involvement or connection with Liberty University that your company or organization may have, including the names of any faculty or staff with whom you have developed a relationship. *

Please provide a brief history of your company or organization * *

Please outline your vision-statement for your company or organization *

What countries do you have ongoing work in? (Please add all that apply to student opportunities) - Including US based opportunities. *

What types of service-engagement does your Organization offer? (Select all that Apply) *

What types of opportunities do you offer? (Select all that apply) *

In an effort to maintain safety and security for our students, our Risk Management department has provided ALL countries that we are unable to send students and promote travel opportunities. Per University policy, you are NOT allowed to recruit students to travel with you or promote any opportunities regardless of the nature to these countries. They currently are out of policy and pose a significant threat to their travel safety, educational outcomes and are prohibited by Liberty University. Due to the nature and seriousness of this policy, we ask that you present any questions to our office regarding specific locations within those various countries listed below. Please reach out to us and we will guide you in what is permissible. We want to serve you through this policy. We cannot thank you enough for both blessing our students while also ensuring the safety of the students’ future engagements.

No Travel Permitted or Promoted:

Iran
North Korea
Democratic Republic of Congo
Balkans
Belarus
Ivory Coast
Cuba
Iraq
Liberia
Sudan
Syria
Zimbabwe
Afghanistan
Libya
Somalia
Yemen
Ukraine
Burundi
Haiti
Madagascar
Tunisia
Central African Republic
Chad
Egypt
India (Jammu and Kashmir Provinces)
Israel (Gaza and West Bank Areas)
Lebanon
Mali
Nigeria
Pakistan
Russia (North Caucasus)
Thailand (Pattani, Yala, Sonkhala, Narathiwat Provinces)
Venezuela

Permission must be granted to promote any potential travel location(s) within each of these listed countries:

Algeria
Bahrain
Bangladesh
Bosnia & Herzegovina
Brazil
Burkina Faso
Cambodia, Phnom Penh
Colombia
East Timor
Ecuador (non-Quito)
El Salvador (San Salvador)
Ethiopia (non-Ababa)
Guatemala
Guinea
Honduras
India (Ahmedabad)
Indonesia
Israel (Jerusalem)
Kenya
Kosovo
Kyrgyzstan
Mauritania
Mexico (non-Guadalajara, non-Cancun, non-San Jose del Cabo, non-Veracruz)
Nepal
Niger
Papua New Guinea
Peru (Lima)
Philippines
Saudi Arabia

I have read and confirm that I can abide by this safety policy? *

Yes No I am confused and need more clarification I have a question pertaining to this policy

Please share with us why your company or organization is seeking to come on campus? *

Please explain the specific opportunities and locations that you are hoping to share with students and how that will add value to their college experience. *

How long do you intend to promote this opportunity at LU (please provide start and end dates) *

How long do you intend to remain on campus each day for recruitment (please provide start and end times) *

Please upload a current Copy or Certificate of your organization's liability/event Insurance (COI). *

Browse Files

Will you need a table/booth setup? *

Yes No

Where would you prefer to have your table set-up for recruiting? (Please list a 2nd and 3rd option for location) *

What will you be bringing for set-up and/or promotional material? *

Please list the departments that you are seeking to connect and recruit from. *

Is there any other information or questions you have prior to coming on campus? *

Convo Select is held on Thursdays from 10:00 - 11:00 AM in the School of Music Concert Hall.

The first 15 minutes of programming is reserved for general announcements for OSD. The total remaining programming should be no more than 45 minutes.

Name of Prospective Guest(s): *

Guest Title: *

Guest Is: *

A Liberty Employee/Professor An Outside Guest

Guests Twitter Handle *

Ex; @guest1

Proposed Honorarium: *

Date *

Date

Topic: *

Topics should follow a TED Talk format that will captivate audiences outside of your particular school. Ex.; "History & Jesus - An exciting look at how the birth of Christ shapes the history of our Nation."

Presentation Preferences: *

Handheld Mic Headset Mic Podium Mic Podium Hightop Table

How many rooms at the Montview Mansion will you need?

Number: *

Host Name: *

Host Phone Number: *

Area Code Phone Number

Convo Select Information Form

Department/School Information

Organization Details

Guest/Event Details

Hospitality