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Home / About Us / Contact Us / Speaking Engagement (SE) Form for Requesting Organization

Speaking Engagement (SE) Form for Requesting Organization

Please submit this completed form at least two weeks prior to the event date.

Requesting Organization*
Organization Mission*
Point of Contact (POC)*
POC Title*
POC Phone Number*
POC Email Address*
Type of Request:*
- Keynote
- Panel
- Plenary
- Welcome/Closing Remarks
- Talking Points
- Testimony/Hearing
Speaker Request*
Other speakers at SE (Speaking engagement) - if any
Date of SE*
Time of SE*
Location (i.e. Organization/School Name) of SE*
Location address*
State*
Zip code*
Does the SE take place during a Conference/Meeting? If yes, please name:
Potential Audience Size*
- 25 or less
- 26-50
- 51-75
- 76-100
- 100+
Subject / Main Focus of Messaging
- Awareness: Increasing awareness of the benefits of higher education
- Access and Preparedness: Improving student access to and preparedness for college
- Success: Improving student success in college
- Productivity: Improving productivity across the higher education system
- 21st Century Students
- Goal 2025
- Domestic & International Policy Developments
- HBCUs
- MSIs
- Personal Experience & Expertise
- Philanthropy
- Workforce
- Other
Audience Type, i.e. Legislators, Community Leaders, Faculty, etc.*
Length of Time Available for SE*
Any additional details you'd like to share

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