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Speech Request - Vice Provost Faculty Affairs

To request a speech or appearance by Vice Provost Alyssa Panitch, you may use this online form. Please submit your request at least two weeks prior to the event. Should you have questions, please contact Annie Jarrard at (765) 494-5425.

Items with an * are required


Name of Event*
Contact Person*
Office Phone*
Description of Event
Day & Date of Event*
Time of Day*
Sponsoring Organization*
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:
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 Alumni in audience: Yes No
If so, who?
Press/Media expected to attend?* Yes No
Names of
media groups represented:
Audio/Visual available
(podium, mic; please describe):
Special Notes:
Written invitations issued? Yes No
By whom?
Expenses of event charged to: