EmailMe Form - President Request Form

Requester's First and Last Name *

First Last

Requester's Phone Number *

Requester's Email *

What is the exact title of the event? *

Date of the event. *

Time of the event. *

Event Location *

Street Address City State / Province / Region Postal / Zip Code

Give a description of the event. *

What organization is hosting the event? Provide background information on the organization. *

Provide a detailed agenda (itinerary or run of show) with start and end times for each segment. *

If you have a copy of your agenda, you can also upload it using the button below.

FILES EXCEPTED: PDF, POWERPOINT, WORD, PNG, JPEG

Primary Contact Person's First and Last Name *

First Last

Primary Contact's Title *

Primary Contact's Number *

Primary Contact's Email *

Include any supporting links regarding event (if applicable).

What are the primary goals and objectives of the event? *

Please select the type of remarks being requested:

Are there specific themes or topics? *

Time expectation for speech (5 min., 10 mins., etc.) *

What are the audience demographics (age range, occupations, interests and backgrounds)? *

Estimated audience size? *

If more than 100, give us an audience range (e.g. 100-400, etc.).

Will the president be required to answer questions from the audience? *

Yes

No

Will there be notable guests or dignitaries in the audience? *

Yes

No

If yes, who is expected?

Who will introduce the president? *

Is the president's photo and/or bio required? *

Yes, please provide his photos.

Yes, please provide his photo and bio.

No

If the president is unavailable, may a university representative be permitted? *

Yes

No

If the president is unavailable, would a video greeting or remarks be permitted? *

Yes

No

What is the event dress code (formal, business professional, business casual, or JSU casual)? *

Will the media be present at the event? *

Yes

No

If so, which outlets?

Important Note: Any flyers or publications that use the image or likeness of President Marcus L. Thompson, Ph.D., or Jackson State University must be submitted for approval to the Division of University Communications prior to distribution. Please email materials to marketing@jsums.edu or call 601-979-2272 with any questions.