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Division of
Diversity and Inclusion
 

Request a Speech or Appearance

Speech/Appearance Request Form

To request a speech or appearance by Dr. G. Christine Taylor, complete this form. Please submit your request at least 3 weeks prior to the event. You may E-mail this completed form to sbrinegar@purdue.edu; fax it to (765) 496-2031; or mail it to the address below. Should you have any questions, please contact Shanna Brinegar at (765) 494-6969.

Office of the Vice Provost for Diversity & Inclusion
Hovde Hall, Room 130
610 Purdue Mall
West Lafayette, IN 47906
Phone: (765) 494-6969

• denotes a required field

Contact Information
Name of event •
Contact person •
E-mail •
Office phone •
Cell phone 
Fax 

Event Information
Description of event 
Day and Date of event •
Attire 
Time of day •
Place •
Hosts 
Phone 
Purpose for visit •
Please attach a PDF of your invitation.

Due to the Vice Provost’s schedule, not all requests can be accepted. If she is not able to attend your event, would you like to have your request submitted to the Purdue Speaker’s Bureau for an alternate suggestion? Yes No

Speech Information
Are remarks requested? • Yes No
Welcoming remarks   (3-5 minutes) Short remarks  (5-10 minutes) Speech (15-20 minutes) Major address   (20 minutes +)
Topic of remarks:

Have you submitted a request within the past year? Yes No
If so, for what event and when?
Will there be other speakers? • Yes No
If so, who and in what order will they speak?

Number of persons estimated to be in attendance:
Dignitaries in the audience: Yes No
If so, who?
Purdue alumniin the audience Yes No
If so, who?
Press/media expected to attend • Yes No
If so, which media groups will be represented?
Audio/Visual
For on-campus engagements, please contact Tim Todd from the Hall of Music for information about reserving a podium and audio equipment.
For events off-campus, please briefly describe available equipment (e.g., podium, sound system, etc.).
Special notes:
Written invitations issued? Yes No
By whom?
Expenses of event charged to:



If someone in the audience needs accommodations such as a sign language interpreter, please contact the Vice Provost’s office at (765) 494-6969 to make special arrangements.