General Information

Organization Name(Required)

Organization mission or brief description(Required)

Contact Name(Required)

First Last

Phone(Required)

Email(Required)

Are you requesting:(Required)

A meeting with the Chancellor

The Chancellor’s attendance at an event

Meeting Information

Meeting Description(Required)

Please provide agenda details, if available, including topics.(Required)

List meeting attendees and provide titles.(Required)

Is this meeting virtual or in person?(Required)

Virtual

In person

Venue Information

Venue Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Room Name

Event Information

Event Name(Required)

Event Description(Required)

Please provide agenda details, if available, including topics.(Required)

Please provide audience profile and estimated audience size.(Required)

Proposed role for the Chancellor(Required)

Is this a virtual or in-person event?(Required)

Virtual

In-person

Venue Information

Venue Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Room name or number(Required)

Date

Requested Date(Required)

Requested start time(Required)

:

End Time(Required)

:

Is your date/time flexible?(Required)

Yes

No

Flexible date and time information

Alternative date(Required)

Please provide availability for this alternative date.(Required)

Alternative

If the Chancellor is unavailable, would you like another CCCS representative to attend?(Required)

Yes

No

Previous Attendee

Has the Chancellor previously met with this person or organization?(Required)

Yes

No

Previous Attendee Info

Most recently attended meeting/event.(Required)

Most recently attended meeting/event date.

Outreach

Will you be promoting this meeting/event externally?

Yes

No

Outreach

Once we confirm the Chancellor’s attendance, you are welcome to tag him in posts using the following.CCCS handles: Facebook: /gocccs X: @GoCCCS

Will media be invited to this event?

Yes

No

How will you be promoting the event?

Please provide links to the Facebook, X, or web page for your organization and/or event. Please provide any preferred hashtags.