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:*KeynotePanelPlenaryWelcome/Closing RemarksTalking PointsTestimony/HearingSpeaker Request*Jim ApplegateSam CargileKevin CorcoranHaley GloverLiz GutierrezSusan JohnsonJeanna Keller BerdelTeresa DetrichMarcus KolbThomas Major, Jr.Molly MartinChristine MarsonDewayne MatthewsJamie MerisotisHoliday Hart McKiernanJulie PellerSheri RanisTina GridironZakiya SmithKiko SuarezHolly ZanvilleUnsure of best choice / allow Lumina to suggestOther speakers at SE (Speaking engagement) - if anyDate of SE*Time of SE*Location (i.e. Organization/School Name) of SE*Location address*State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip code*Does the SE take place during a Conference/Meeting? If yes, please name:Potential Audience Size*25 or less26-5051-7576-100100+Subject / Main Focus of MessagingAwareness: Increasing awareness of the benefits of higher educationAccess 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 StudentsGoal 2025Domestic & International Policy DevelopmentsHBCUsMSIsPersonal Experience & ExpertisePhilanthropyWorkforceOtherAudience Type, i.e. Legislators, Community Leaders, Faculty, etc.*Length of Time Available for SE*Any additional details you'd like to share Comments are closed.